Provider Demographics
NPI:1952434979
Name:ATLANTIC COAST ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:ATLANTIC COAST ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRISTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-926-7400
Mailing Address - Street 1:401 NEW RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1200
Mailing Address - Country:US
Mailing Address - Phone:609-926-7400
Mailing Address - Fax:609-926-9518
Practice Address - Street 1:1100 ROUTE 72 W
Practice Address - Street 2:STE 306
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2468
Practice Address - Country:US
Practice Address - Phone:609-926-7400
Practice Address - Fax:609-926-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02546800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID NUMBER
NJ079404Medicare ID - Type UnspecifiedMEDICARE NUMBER
4621330002Medicare NSC
NJD98843Medicare UPIN