Provider Demographics
NPI:1386079978
Name:NORTH JERSEY SPORTS MEDICINE & ORTHOPEDIC CENTER, LLC
Entity type:Organization
Organization Name:NORTH JERSEY SPORTS MEDICINE & ORTHOPEDIC CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-684-2480
Mailing Address - Street 1:376 LAFAYETTE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3560
Mailing Address - Country:US
Mailing Address - Phone:908-684-2480
Mailing Address - Fax:908-684-3301
Practice Address - Street 1:376 LAFAYETTE RD STE 202
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3560
Practice Address - Country:US
Practice Address - Phone:908-684-3005
Practice Address - Fax:908-684-3301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH JERSEY SPORTS MEDICINE & ORTHOPEDIC C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-13
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06971100174400000X
NJ25MB06992500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5725900001Medicare NSC
NJ100250Medicare PIN