Provider Demographics
NPI:1912097312
Name:PACE ORTHOPEDICS AND SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:PACE ORTHOPEDICS AND SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-927-9200
Mailing Address - Street 1:547 NEW RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2038
Mailing Address - Country:US
Mailing Address - Phone:609-927-9200
Mailing Address - Fax:609-927-1616
Practice Address - Street 1:547 NEW RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2038
Practice Address - Country:US
Practice Address - Phone:609-927-9200
Practice Address - Fax:609-927-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ613778Medicare PIN
NJ0921210001Medicare NSC
NJCE7307Medicare PIN