Provider Demographics
NPI:1215248299
Name:MAM ORTHOPAEDICS, PA
Entity type:Organization
Organization Name:MAM ORTHOPAEDICS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-968-0508
Mailing Address - Street 1:17 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4702
Mailing Address - Country:US
Mailing Address - Phone:201-968-0508
Mailing Address - Fax:201-968-0509
Practice Address - Street 1:17 ELM AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4702
Practice Address - Country:US
Practice Address - Phone:201-968-0508
Practice Address - Fax:201-968-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ255MA05232100163WX0800X
NJ25MA05232100207XX0005X
208100000X, 332B00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85571Medicare UPIN