MEDICARE: PEDIATRIC ORTHOPEDIC SPECIALTIES, 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	174400000X	Specialist	25MA06975500	NJ

General Provider Information

NPI Number	:	1821030545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC ORTHOPEDIC SPECIALTIES, PA

Provider Business Mailing Address
First Line	:	22 MADISON AVE
Second Line	:	SUITE 3
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2734
Country	:	US
Telephone Number	:	201-342-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 MADISON AVE
Second Line	:	SUITE 3
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2734
Country	:	US
Telephone Number	:	201-342-4100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD SNYDER
Credential	:	MD
Telephone Number	:	201-342-4100

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	11/02/2007

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