Healthcare Provider Details

I. General information

NPI: 1609815067
Provider Name (Legal Business Name): RIDGEWOOD ORTHOPEDIC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S MAPLE AVE
RIDGEWOOD NJ
07450-4561
US

IV. Provider business mailing address

85 S MAPLE AVE
RIDGEWOOD NJ
07450-4561
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2830
  • Fax:
Mailing address:
  • Phone: 201-445-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA02491500
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH P PIZZURRO
Title or Position: PARTNER
Credential: MD
Phone: 201-445-2830