Provider Demographics
NPI:1124354543
Name:NEW JERSEY JANEDA ORTHOPEDICS INC
Entity type:Organization
Organization Name:NEW JERSEY JANEDA ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-735-5779
Mailing Address - Street 1:6 SYLVAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2431
Mailing Address - Country:US
Mailing Address - Phone:201-735-5779
Mailing Address - Fax:201-735-5887
Practice Address - Street 1:6 SYLVAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2431
Practice Address - Country:US
Practice Address - Phone:201-735-5779
Practice Address - Fax:201-735-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08649300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ168079Medicare PIN