MEDICARE: ANDOVER ORTHOPAEDIC SURGERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QP2000X	Physical Therapy Clinic/Center
2	261QR0400X	Rehabilitation Clinic/Center
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number	:	1538102157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDOVER ORTHOPAEDIC SURGERY

Provider Business Mailing Address
First Line	:	280 NEWTON SPARTA RD
Second Line	:	SUITE 4
City	:	NEWTON
State	:	NJ
Zip	:	07860-2775
Country	:	US
Telephone Number	:	973-293-7513
Fax Number	:	973-293-7571

Provider Business Practice Location Address
First Line	:	452 US HIGHWAY 206
Second Line	:
City	:	MONTAGUE
State	:	NJ
Zip	:	07827
Country	:	US
Telephone Number	:	973-293-7513
Fax Number	:	973-293-7571

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ROBIN BACALOGLU
Credential	:
Telephone Number	:	973-579-7443

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/11/2007

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Directions to “ANDOVER ORTHOPAEDIC SURGERY ” Practice Location

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