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NPI Code Detail

MEDICARE: RIDGEWOOD ORTHOPEDIC GROUP, LLC

MEDICARE: RIDGEWOOD ORTHOPEDIC GROUP, 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
1174400000XSpecialist25MA02491500NJ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
36471940001OTHERNJMEDICARE DME
4CB2844OTHERNJRAILROAD MEDICARE GROUP #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11043687OTHERNJAETNA HMO GROUP #
25153671OTHERNJAETNA PPO GROUP #

General Provider Information

NPI Number : 1609815067
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIDGEWOOD ORTHOPEDIC GROUP, LLC
Provider Business Mailing Address
First Line : 85 S MAPLE AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-4561
Country : US
Telephone Number : 201-445-2830
Fax Number :
Provider Business Practice Location Address
First Line : 85 S MAPLE AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-4561
Country : US
Telephone Number : 201-445-2830
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : DR. JOSEPH P PIZZURRO
Credential : MD
Telephone Number : 201-445-2830
Provider Enumeration Date : 06/04/2006
Last Update Date : 09/28/2011

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Directions to “RIDGEWOOD ORTHOPEDIC GROUP, LLC ” Practice Location

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