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General NPI Number Information
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NPI Number | 1679637052
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, INC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 719 NORTH BEERS ST SUITE C-1
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City | HOLMDEL
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State | NJ
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Zip | 07733
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Country | US
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Telephone | 732-888-2100
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Fax | 732-888-2188
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | HOLMDEL
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State | NJ
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Zip | 07733
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Country | US
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Telephone | 732-888-2100
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Fax | 732-888-2188
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Authorized Official
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Title or Position | OWNER
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Name | DAVID LOPEZ
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Credential | MD
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Telephone | 732-888-2100
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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 | 25MA07887100
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License Number State | NJ
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