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General NPI Number Information
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NPI Number | 1881969889
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Entity Type | Organization
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Legal Business Name | SPECIALTY ORTHOPAEDICS, LLC
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 609 MORRIS AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-1511
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Country | US
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Telephone | 973-379-1991
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Fax | 973-467-8647
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Provider Business Mailing Address
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Address Line | 609 MORRIS AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-1511
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Country | US
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Telephone | 973-379-1991
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Fax | 973-467-8647
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BEVERLY A JENNINGS
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Credential |
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Telephone | 973-379-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA042618
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License Number State | NJ
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