Healthcare Provider Details

I. General information

NPI: 1598263360
Provider Name (Legal Business Name): ORTHOPAEDIC INSTITUTE OF CENTRAL JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 BROAD ST
RED BANK NJ
07701-2150
US

IV. Provider business mailing address

2315 HIGHWAY 34 STE D
MANASQUAN NJ
08736-1444
US

V. Phone/Fax

Practice location:
  • Phone: 732-933-4300
  • Fax:
Mailing address:
  • Phone:
  • 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: ANTHONY V PETROSINI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 732-974-0404