Provider Demographics
NPI:1649724840
Name:PJO ORTHOPEDIC SUPPLIES LLC
Entity type:Organization
Organization Name:PJO ORTHOPEDIC SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:732-530-1164
Mailing Address - Street 1:716 NEWMAN SPRINGS RD
Mailing Address - Street 2:UNIT 151
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1523
Mailing Address - Country:US
Mailing Address - Phone:732-530-1164
Mailing Address - Fax:
Practice Address - Street 1:716 NEWMAN SPRINGS RD
Practice Address - Street 2:UNIT 151
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1523
Practice Address - Country:US
Practice Address - Phone:732-530-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies