Provider Demographics
NPI:1881057123
Name:SOMERSET ORTHOPEDICS & SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:SOMERSET ORTHOPEDICS & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:908-809-1000
Mailing Address - Street 1:1 ROBERTSON DR STE 24
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1716
Mailing Address - Country:US
Mailing Address - Phone:908-809-1000
Mailing Address - Fax:908-809-1012
Practice Address - Street 1:1 ROBERTSON DR STE 24
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1716
Practice Address - Country:US
Practice Address - Phone:908-809-1000
Practice Address - Fax:908-809-1012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMERSET ORTHOPEDIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty