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General NPI Number Information
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NPI Number | 1407246945
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Entity Type | Organization
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Legal Business Name | NJ ORTHO GROUP
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 234 INDUSTRIAL WAY W SUITE A200
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City | EATONTOWN
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State | NJ
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Zip | 07724-4244
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Country | US
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Telephone | 732-542-6000
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Fax | 732-542-6001
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Provider Business Mailing Address
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Address Line | 234 INDUSTRIAL WAY W SUITE A200
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City | EATONTOWN
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State | NJ
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Zip | 07724-4244
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Country | US
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Telephone | 732-542-6000
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Fax | 732-542-6001
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. GORDON DUTHIE DONALD III
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Credential | M.D.
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Telephone | 732-542-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0400359999
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License Number State | NJ
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