Healthcare Provider Details

I. General information

NPI: 1720898729
Provider Name (Legal Business Name): GARDEN STATE ORTHOPAEDIC ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LINCOLN HWY STE 300
ISELIN NJ
08830-1536
US

IV. Provider business mailing address

28-04 BROADWAY
FAIR LAWN NJ
07410-3920
US

V. Phone/Fax

Practice location:
  • Phone: 201-791-4434
  • Fax:
Mailing address:
  • Phone: 201-791-4434
  • Fax:

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 Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ROTHSCHILD
Title or Position: ADMINISTRATOR
Credential: M.S., FACMPE, CASC
Phone: 201-791-4434