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General NPI Number Information
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NPI Number | 1013342609
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Entity Type | Organization
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Legal Business Name | NORTH JERSEY SPORTS MEDICINE & ORTHOPEDIC CENTER, LLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 711 ROUTE 10 E STE 100
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City | RANDOLPH
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State | NJ
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Zip | 07869-2030
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Country | US
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Telephone | 908-684-3005
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Fax | 908-684-3301
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Provider Business Mailing Address
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Address Line | 376 LAFAYETTE RD STE 202
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City | SPARTA
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State | NJ
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Zip | 07871-3560
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Country | US
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Telephone | 908-684-3005
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Fax | 908-684-3301
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT A DEFALCO JR.
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Credential | M.D.
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Telephone | 908-684-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MB06992500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MB06971100
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License Number State | NJ
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