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General NPI Number Information
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NPI Number | 1669415287
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Entity Type | Organization
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Legal Business Name | ANDOVER ORTHOPAEDIC SURGERY & SPORTS MEDICINE, PA
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 280 NEWTON SPARTA RD SUITE 4
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City | NEWTON
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State | NJ
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Zip | 07860
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Country | US
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Telephone | 973-579-7443
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Fax | 973-579-7218
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Provider Business Mailing Address
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Address Line | 280 NEWTON SPARTA RD SUITE 4
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City | NEWTON
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State | NJ
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Zip | 07860
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Country | US
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Telephone | 973-579-7443
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Fax | 973-579-6395
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ROBIN BACALOGLU
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Credential |
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Telephone | 973-579-7443
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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 |
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License Number State |
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