Healthcare Provider Details

I. General information

NPI: 1932622966
Provider Name (Legal Business Name): MID ATLANTIC ORTHOPEDIC ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 CRANBURY RD STE 10
EAST BRUNSWICK NJ
08816-5419
US

IV. Provider business mailing address

557 CRANBURY RD STE 10
EAST BRUNSWICK NJ
08816-5419
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-8800
  • Fax: 732-238-2270
Mailing address:
  • Phone: 732-238-8800
  • Fax: 732-238-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMA059416
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMA07643200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMA08156400
License Number StateNJ

VIII. Authorized Official

Name: JORDAN SALAHI
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 908-490-0036