Healthcare Provider Details

I. General information

NPI: 1245725191
Provider Name (Legal Business Name): CITY ORTHOPAEDICS & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PATERSON AVE STE 302
EAST RUTHERFORD NJ
07073-1841
US

IV. Provider business mailing address

196 PATERSON AVE STE 302
EAST RUTHERFORD NJ
07073-1841
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-9450
  • Fax: 201-500-9451
Mailing address:
  • Phone: 201-500-9450
  • Fax: 201-500-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LAYLA BARAKAT
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 201-500-9450