Healthcare Provider Details

I. General information

NPI: 1760709158
Provider Name (Legal Business Name): PASSAIC ORTHOPEDIC GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HACKENSACK AVE FLOOR 10
HACKENSACK NJ
07601-6411
US

IV. Provider business mailing address

401 HACKENSACK AVE FLOOR 10
HACKENSACK NJ
07601-6411
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-3999
  • Fax:
Mailing address:
  • Phone: 201-343-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07659600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RICHARD SELDES
Title or Position: OWNER
Credential: M.D.
Phone: 201-343-3999