=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720015696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPAEDIC SURGICAL ASSOCIATES,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 OVERLOOK RD SUITE 201
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-522-4555
-----------------------------------------------------
Fax | 908-522-1128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 OVERLOOK RD SUITE 201
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-522-4555
-----------------------------------------------------
Fax | 908-522-1128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FRANCIS N DELUCA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 908-522-4555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------