=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003875022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COHANZICK ORTHOPEDICS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2006
-----------------------------------------------------
Last Update Date | 12/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 MANHEIM AVENUE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-451-9161
-----------------------------------------------------
Fax | 856-455-8075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 MANHEIM AVENUE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-451-9161
-----------------------------------------------------
Fax | 856-455-8075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. INA O LEVITSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-451-9161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------