Healthcare Provider Details

I. General information

NPI: 1770655870
Provider Name (Legal Business Name): ORTHOPEDICS AT 215 UNION AVENUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 UNION AVE SUITE B
BRIDGEWATER NJ
08807-3063
US

IV. Provider business mailing address

215 UNION AVE SUITE B
BRIDGEWATER NJ
08807-3063
US

V. Phone/Fax

Practice location:
  • Phone: 908-685-8500
  • Fax: 908-685-8009
Mailing address:
  • Phone: 908-685-8500
  • Fax: 908-685-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA07898900
License Number StateNJ

VIII. Authorized Official

Name: DR. THOMAS J NORDSTROM
Title or Position: OWNER
Credential: M.D.
Phone: 908-685-8500