=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730320151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A O ASSOCIATED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2009
-----------------------------------------------------
Last Update Date | 03/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 STUYVESANT AVE 2ND FLOOR
-----------------------------------------------------
City | UNION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07083-6936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-964-6600
-----------------------------------------------------
Fax | 908-364-1016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 STUYVESANT AVE 2ND FLOOR
-----------------------------------------------------
City | UNION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07083-6936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-964-6600
-----------------------------------------------------
Fax | 908-364-1016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | CONNIE TREONZE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-964-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MB42873
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------