Healthcare Provider Details

I. General information

NPI: 1326211509
Provider Name (Legal Business Name): MAHWAH VALLEY ORTHOPEDIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRANKLIN TPKE STE 100
MAHWAH NJ
07430-3516
US

IV. Provider business mailing address

400 FRANKLIN TPKE STE 100
MAHWAH NJ
07430-3516
US

V. Phone/Fax

Practice location:
  • Phone: 201-818-4344
  • Fax: 201-818-2710
Mailing address:
  • Phone: 201-818-4344
  • Fax: 201-818-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMA53478
License Number StateNJ

VIII. Authorized Official

Name: DR. NICHOLAS ALEXANDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-818-4344