Healthcare Provider Details

I. General information

NPI: 1831440841
Provider Name (Legal Business Name): INNOVATIVE ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 UNION AVE SUITE 1B
MIDDLESEX NJ
08846-1962
US

IV. Provider business mailing address

495 UNION AVE SUITE 1B
MIDDLESEX NJ
08846-1962
US

V. Phone/Fax

Practice location:
  • Phone: 732-667-5000
  • Fax: 908-722-2200
Mailing address:
  • Phone: 732-667-5000
  • Fax: 908-722-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA JEAN ELARDO-REPAK
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-667-5000