MEDICARE: TRI-STATE ORTHOPEDICS

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	207X00000X	Orthopaedic Surgery Physician	25MD03065800	NJ

General Provider Information

NPI Number	:	1669741054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE ORTHOPEDICS

Provider Business Mailing Address
First Line	:	350 SPARTA AVE
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1120
Country	:	US
Telephone Number	:	973-729-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 SPARTA AVE
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1120
Country	:	US
Telephone Number	:	973-729-1113
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MARIE ANN MARGIOTTI
Credential	:	MD
Telephone Number	:	973-729-1113

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	12/14/2011

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Directions to “TRI-STATE ORTHOPEDICS ” Practice Location

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