=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215248299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAM ORTHOPAEDICS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2010
-----------------------------------------------------
Last Update Date | 08/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 ELM AVE
-----------------------------------------------------
City | HACKENSACK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07601-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-968-0508
-----------------------------------------------------
Fax | 201-968-0509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 ELM AVE
-----------------------------------------------------
City | HACKENSACK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07601-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-968-0508
-----------------------------------------------------
Fax | 201-968-0509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. MICHAEL A. MEESE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 201-968-0508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 25MA05232100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------