Provider Demographics
NPI:1740319607
Name:CENTER FOR ORTHOPAEDIC SURGERY, LLP
Entity type:Organization
Organization Name:CENTER FOR ORTHOPAEDIC SURGERY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-409-9494
Mailing Address - Street 1:3612 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2039
Mailing Address - Country:US
Mailing Address - Phone:718-409-9494
Mailing Address - Fax:718-824-8026
Practice Address - Street 1:3612 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2039
Practice Address - Country:US
Practice Address - Phone:718-409-9494
Practice Address - Fax:718-824-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209052207X00000X, 207XS0106X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02652OtherMEDICARE ID TYPE
NY01822375Medicaid
NYW8J962Medicare ID - Type Unspecified
NY01822375Medicaid