Provider Demographics
NPI:1194900563
Name:ORTHOPEDIC SPECIALTIES OF NEW JERSEY, INC.
Entity type:Organization
Organization Name:ORTHOPEDIC SPECIALTIES OF NEW JERSEY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT C.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CERT LIC ORTHOTIST
Authorized Official - Phone:201-262-4330
Mailing Address - Street 1:134 MUNSEY RD.
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1514
Mailing Address - Country:US
Mailing Address - Phone:201-262-4330
Mailing Address - Fax:201-265-3521
Practice Address - Street 1:340 WEST PASSAIC ST.
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3018
Practice Address - Country:US
Practice Address - Phone:201-843-2008
Practice Address - Fax:201-843-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0441330001Medicare NSC