=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124354543
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW JERSEY JANEDA ORTHOPEDICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2009
-----------------------------------------------------
Last Update Date | 02/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 SYLVAN AVE SUITE E
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632-2431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-735-5779
-----------------------------------------------------
Fax | 201-735-5887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 SYLVAN AVE SUITE E
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632-2431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-735-5779
-----------------------------------------------------
Fax | 201-735-5887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL YOO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 201-735-5779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MA08649300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------