Healthcare Provider Details

I. General information

NPI: 1902101371
Provider Name (Legal Business Name): KONIGSBERG PEDIATRIC ORTHOPAEDICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GODWIN AVE SUITE 4
MIDLAND PARK NJ
07432-1468
US

IV. Provider business mailing address

600 GODWIN AVE SUITE 4
MIDLAND PARK NJ
07432-1468
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-9000
  • Fax: 201-996-9301
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID KONIGSBERG
Title or Position: OWNER
Credential: MD
Phone: 201-445-9000