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General NPI Number Information
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NPI Number | 1376819250
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Entity Type | Organization
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Legal Business Name | GARDEN STATE ORTHOPAEDIC ASSOCIATES, P.A.
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 400 FRANKLIN TPKE SUITE 112
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City | MAHWAH
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State | NJ
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Zip | 07430-3516
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Country | US
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Telephone | 201-825-2266
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Fax |
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Provider Business Mailing Address
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Address Line | 28-04 BROADWAY
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City | FAIR LAWN
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State | NJ
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Zip | 07410-3913
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Country | US
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Telephone | 201-791-4434
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH A LEVITSKY
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Credential | M.D.
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Telephone | 201-791-4434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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