MEDICARE: NORTH JERSEY SPORTS MEDICINE & ORTHOPEDIC CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MB06992500	NJ
2	174400000X	Specialist	25MB06971100	NJ

General Provider Information

NPI Number	:	1386079978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY SPORTS MEDICINE & ORTHOPEDIC CENTER, LLC

Provider Business Mailing Address
First Line	:	376 LAFAYETTE RD STE 202
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-3560
Country	:	US
Telephone Number	:	908-684-2480
Fax Number	:	908-684-3301

Provider Business Practice Location Address
First Line	:	376 LAFAYETTE RD STE 202
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-3560
Country	:	US
Telephone Number	:	908-684-3005
Fax Number	:	908-684-3301

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SANDRA SCHEIDER
Credential	:
Telephone Number	:	908-684-2480

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	08/01/2023

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