Provider Demographics
NPI:1245629856
Name:GARDEN STATE ORTHOPAEDIC ASSOC, PA
Entity type:Organization
Organization Name:GARDEN STATE ORTHOPAEDIC ASSOC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHSCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-791-4434
Mailing Address - Street 1:28-04 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3913
Mailing Address - Country:US
Mailing Address - Phone:201-791-4434
Mailing Address - Fax:201-791-9377
Practice Address - Street 1:28-04 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3913
Practice Address - Country:US
Practice Address - Phone:201-791-4434
Practice Address - Fax:201-791-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05941700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty