Healthcare Provider Details

I. General information

NPI: 1609898691
Provider Name (Legal Business Name): ORTHOPAEDIC AND SPORTS SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 WHITE HORSE PIKE STE 101
ATCO NJ
08004-2257
US

IV. Provider business mailing address

798 S ROUTE 73
WEST BERLIN NJ
08091-2620
US

V. Phone/Fax

Practice location:
  • Phone: 856-809-9001
  • Fax: 856-809-9003
Mailing address:
  • Phone: 856-809-9001
  • Fax: 856-809-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA46475
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RHONDA ROMERO
Title or Position: OFFICE MGR.
Credential:
Phone: 856-809-9001