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General NPI Number Information
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NPI Number | 1700915592
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Entity Type | Organization
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Legal Business Name | NORTH JERSEY PEDIATRIC ORTHPEDICS PA
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 140 CHESTNUT ST SUITE 201
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2599
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Country | US
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Telephone | 210-445-2457
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Fax | 201-445-9050
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Provider Business Mailing Address
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Address Line | 140 CHESTNUT ST SUITE 201
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2599
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Country | US
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Telephone | 210-445-2457
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Fax | 201-445-9050
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS AVELLA
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Credential | MD
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Telephone | 201-445-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | MA39087
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License Number State | NJ
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