Healthcare Provider Details

I. General information

NPI: 1447213962
Provider Name (Legal Business Name): TRI-COUNTY ORTHOPAEDIC & SPORTS MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 RIDGEDALE AVE
CEDAR KNOLLS NJ
07927-2111
US

IV. Provider business mailing address

PO BOX 1446
MORRISTOWN NJ
07962-1446
US

V. Phone/Fax

Practice location:
  • Phone: 973-538-2334
  • Fax:
Mailing address:
  • Phone: 973-538-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04208000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK J. MCBRIDE
Title or Position: DIRECTOR
Credential: MD
Phone: 973-538-2334