MEDICARE: UMDNJ RWJ UNIV ORTHOPAEDIC GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1548213424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UMDNJ RWJ UNIV ORTHOPAEDIC GROUP

Provider Business Mailing Address
First Line	:	66 W GILBERT ST
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701
Country	:	US
Telephone Number	:	732-212-0051
Fax Number	:	732-212-0713

Provider Business Practice Location Address
First Line	:	215 EASTON AVE
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-1722
Country	:	US
Telephone Number	:	732-545-0400
Fax Number	:	732-545-0465

Authorized Official
Title or Position	:	CREDENTIALS MANAGER
Name	:	CAROLE PENZYNSKI
Credential	:
Telephone Number	:	732-212-0061

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/01/2008

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