Healthcare Provider Details

I. General information

NPI: 1578359394
Provider Name (Legal Business Name): NJ ORTHOPEDIC AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 KINGSLAND ST
NUTLEY NJ
07110-1119
US

IV. Provider business mailing address

PO BOX 70
NUTLEY NJ
07110-0070
US

V. Phone/Fax

Practice location:
  • Phone: 855-699-7246
  • Fax: 718-766-9763
Mailing address:
  • Phone: 973-816-2259
  • Fax: 718-766-9763

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 Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. NEESHA N MOHAMMED
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 201-340-2199