MEDICARE: SPORTS MEDICINE PHYSICIAN ASSOCIATES, 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	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1669635157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS MEDICINE PHYSICIAN ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	550 KINDERKAMACK RD
Second Line	:	SUITE 203
City	:	ORADELL
State	:	NJ
Zip	:	07649-1500
Country	:	US
Telephone Number	:	201-265-7747
Fax Number	:	201-265-7748

Provider Business Practice Location Address
First Line	:	550 KINDERKAMACK RD
Second Line	:	SUITE 203
City	:	ORADELL
State	:	NJ
Zip	:	07649-1500
Country	:	US
Telephone Number	:	201-265-7747
Fax Number	:	201-265-7748

Authorized Official
Title or Position	:	OWNER / SOLE MEMBER
Name	:	DR. JAMES CHRISTOPHER MENDLER
Credential	:	M.D.
Telephone Number	:	201-265-7747

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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