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General NPI Number Information
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NPI Number | 1487494480
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Entity Type | Organization
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Legal Business Name | MCCULLOCH ORTHOPAEDIC SURGICAL SERVICES OF NJ LLC
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 801 KENNEDY BLVD
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City | BAYONNE
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State | NJ
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Zip | 07002-2810
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Country | US
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Telephone | 212-355-5555
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Fax | 877-992-0798
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Provider Business Mailing Address
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Address Line | 520 FRANKLIN AVE STE 211
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City | GARDEN CITY
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State | NY
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Zip | 11530-5815
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Country | US
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Telephone | 212-355-5555
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Fax | 877-992-0798
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Authorized Official
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Title or Position | COO/CFO
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Name | MR. ANDREW MCCULLOCH
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Credential |
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Telephone | 734-645-3899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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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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