Provider Demographics
NPI:1588780415
Name:EDISON ORTHOPAEDIC INSTITUTE PA
Entity type:Organization
Organization Name:EDISON ORTHOPAEDIC INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-834-8343
Mailing Address - Street 1:3 PROGRESS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1180
Mailing Address - Country:US
Mailing Address - Phone:908-834-8343
Mailing Address - Fax:
Practice Address - Street 1:3 PROGRESS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1180
Practice Address - Country:US
Practice Address - Phone:908-834-8343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB50296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200011599OtherRAILROAD MEDICARE NUMBER
NJ0219520001OtherCIGNA GROUP NUMBER
NJ4608535OtherAETNA GROUP NUMBER
NJ0219520001OtherCIGNA GROUP NUMBER
NJ=========000OtherQUALCARE GROUP NUMBER