Provider Demographics
NPI:1104992593
Name:ADVANCED ORTHOPAEDICS PLLC
Entity type:Organization
Organization Name:ADVANCED ORTHOPAEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-575-5454
Mailing Address - Street 1:8002 KEW GARDENS RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:718-575-5454
Mailing Address - Fax:718-575-0098
Practice Address - Street 1:8002 KEW GARDENS RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415
Practice Address - Country:US
Practice Address - Phone:718-575-5454
Practice Address - Fax:718-575-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1523851207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C1564OtherHEALTHNET
NY00826480Medicaid
NYDS437OtherOXFORD
E43086Medicare UPIN
NY00826480Medicaid