Healthcare Provider Details

I. General information

NPI: 1215761580
Provider Name (Legal Business Name): ORTHOENGLEWOOD BRACING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S DEAN ST STE 202
ENGLEWOOD NJ
07631-3515
US

IV. Provider business mailing address

34 S DEAN ST STE 202
ENGLEWOOD NJ
07631-3515
US

V. Phone/Fax

Practice location:
  • Phone: 551-369-1250
  • Fax: 551-369-1199
Mailing address:
  • Phone: 551-369-1250
  • Fax: 551-369-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. THOMAS YOUM
Title or Position: PARTNER
Credential: MD
Phone: 551-369-1250