Provider Demographics
NPI:1932397502
Name:ORTHPAEDIC & SPORTS MEDICINE ASSOCIATES,P.A.
Entity Type:Organization
Organization Name:ORTHPAEDIC & SPORTS MEDICINE ASSOCIATES,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESFORMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-261-6351
Mailing Address - Street 1:440 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-2302
Mailing Address - Country:US
Mailing Address - Phone:201-261-6351
Mailing Address - Fax:201-261-2805
Practice Address - Street 1:440 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-2302
Practice Address - Country:US
Practice Address - Phone:201-261-6351
Practice Address - Fax:201-261-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41635174400000X
NJ25MA07735800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCD2332OtherRAILROAD MEDICARE
NJOR527947Medicare UPIN