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General NPI Number Information
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NPI Number | 1588740195
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Entity Type | Organization
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Legal Business Name | NORTHLANDS ORTHOPAEDIC & SPORTS MEDICINE PA
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 504 VALLEY RD SUITE 200
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City | WAYNE
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State | NJ
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Zip | 07470-3534
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Country | US
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Telephone | 973-694-2690
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Fax | 973-694-2692
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Provider Business Mailing Address
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Address Line | 504 VALLEY RD SUITE 200
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City | WAYNE
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State | NJ
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Zip | 07470-3534
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Country | US
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Telephone | 973-694-2690
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Fax | 973-694-2692
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | VINCENT K MCINERNEY
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Credential | MD
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Telephone | 973-694-2690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 25MA05626700
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License Number State | NJ
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