=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831207745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARTZBAND CENTER FOR HIP & KNEE REPLACEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 01/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 FOREST AVE
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-5242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-291-4040
-----------------------------------------------------
Fax | 201-291-0404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 29008
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07101-9008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-845-9300
-----------------------------------------------------
Fax | 201-845-9301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MARK HARTZBAND
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 201-291-4040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------