Healthcare Provider Details

I. General information

NPI: 1215248299
Provider Name (Legal Business Name): MAM ORTHOPAEDICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ELM AVE
HACKENSACK NJ
07601-4702
US

IV. Provider business mailing address

17 ELM AVE
HACKENSACK NJ
07601-4702
US

V. Phone/Fax

Practice location:
  • Phone: 201-968-0508
  • Fax: 201-968-0509
Mailing address:
  • Phone: 201-968-0508
  • Fax: 201-968-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA05232100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL A. MEESE
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 201-968-0508