Healthcare Provider Details

I. General information

NPI: 1992383780
Provider Name (Legal Business Name): NORTH JERSEY SPORTS MEDICINE & ORTHOPEDIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ROUTE 10 E STE 100
RANDOLPH NJ
07869-2030
US

IV. Provider business mailing address

376 LAFAYETTE RD STE 202
SPARTA NJ
07871-3560
US

V. Phone/Fax

Practice location:
  • Phone: 908-684-3005
  • Fax:
Mailing address:
  • Phone: 908-684-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA SCHEIDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 908-684-2480