Provider Demographics
NPI:1811318496
Name:GOTHAM CITY ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:GOTHAM CITY ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-330-9200
Mailing Address - Street 1:100 TOWN SQUARE PL
Mailing Address - Street 2:SUITE-208
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2778
Mailing Address - Country:US
Mailing Address - Phone:973-928-1325
Mailing Address - Fax:973-365-2333
Practice Address - Street 1:100 TOWN SQUARE PL STE 208
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-2778
Practice Address - Country:US
Practice Address - Phone:973-928-1325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty