MEDICARE: PROFESSIONAL ORTHOPAEDIC ASSOC PA

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	207L00000X	Anesthesiology Physician
2	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0250340001	OTHER	NJ	MEDICARE DMER IDENTIFIER

General Provider Information

NPI Number	:	1669459855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL ORTHOPAEDIC ASSOC PA

Provider Business Mailing Address
First Line	:	776 SHREWSBURY AVE
Second Line	:	SUITE 201
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3006
Country	:	US
Telephone Number	:	732-530-4949
Fax Number	:	732-530-3618

Provider Business Practice Location Address
First Line	:	776 SHREWSBURY AVE
Second Line	:	SUITE 201
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3006
Country	:	US
Telephone Number	:	732-530-4949
Fax Number	:	732-530-3618

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CHRISTOPHER D JOHNSON
Credential	:	MD
Telephone Number	:	732-530-4949

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	04/14/2014

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Directions to “PROFESSIONAL ORTHOPAEDIC ASSOC PA ” Practice Location

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