Healthcare Provider Details

I. General information

NPI: 1538102157
Provider Name (Legal Business Name): ANDOVER ORTHOPAEDIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 US HIGHWAY 206
MONTAGUE NJ
07827
US

IV. Provider business mailing address

280 NEWTON SPARTA RD SUITE 4
NEWTON NJ
07860-2775
US

V. Phone/Fax

Practice location:
  • Phone: 973-293-7513
  • Fax: 973-293-7571
Mailing address:
  • Phone: 973-293-7513
  • Fax: 973-293-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBIN BACALOGLU
Title or Position: BILLING MANAGER
Credential:
Phone: 973-579-7443