Provider Demographics
NPI:1669741054
Name:TRI-STATE ORTHOPEDICS
Entity type:Organization
Organization Name:TRI-STATE ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARGIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-729-1113
Mailing Address - Street 1:350 SPARTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1120
Mailing Address - Country:US
Mailing Address - Phone:973-729-1113
Mailing Address - Fax:
Practice Address - Street 1:350 SPARTA AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1120
Practice Address - Country:US
Practice Address - Phone:973-729-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD03065800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE80616Medicare UPIN