Provider Demographics
NPI:1780813261
Name:CTO ORTHOPAEDICS LLC
Entity type:Organization
Organization Name:CTO ORTHOPAEDICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUKUEKE
Authorized Official - Middle Name:TOBENNA
Authorized Official - Last Name:OKEZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-265-3111
Mailing Address - Street 1:PO BOX 1732
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-1732
Mailing Address - Country:US
Mailing Address - Phone:201-265-3111
Mailing Address - Fax:
Practice Address - Street 1:351 EVELYN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2901
Practice Address - Country:US
Practice Address - Phone:201-265-3111
Practice Address - Fax:201-265-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06793200261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7720106Medicaid
6266120001Medicare NSC