Provider Demographics
NPI:1841678166
Name:GARDEN STATE ORTHOPAEDIC ASSOCIATES,P.A.
Entity type:Organization
Organization Name:GARDEN STATE ORTHOPAEDIC ASSOCIATES,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORPORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-475-0019
Mailing Address - Street 1:2 SYLVAN WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3809
Mailing Address - Country:US
Mailing Address - Phone:201-791-9733
Mailing Address - Fax:201-791-4434
Practice Address - Street 1:2 SYLVAN WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3809
Practice Address - Country:US
Practice Address - Phone:201-791-9733
Practice Address - Fax:201-791-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00085800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty