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General NPI Number Information
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NPI Number | 1164708806
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Entity Type | Organization
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Legal Business Name | CHAMPION ORTHOPEDICS
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 3635 QUAKERBRIDGE RD STE 3
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City | HAMILTON
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State | NJ
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Zip | 08619-1247
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Country | US
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Telephone | 609-689-2603
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Fax | 609-689-4640
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Provider Business Mailing Address
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Address Line | 3635 QUAKERBRIDGE RD STE 3
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City | HAMILTON
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State | NJ
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Zip | 08619-1247
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Country | US
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Telephone | 609-689-2603
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Fax | 609-689-4640
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STEPHANIE J LONG
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Credential |
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Telephone | 609-689-2603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 25MA04745000
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License Number State | NJ
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