Provider Demographics
NPI:1861434656
Name:RAHWAY EDISON ORTHOPEDIC GROUP PA
Entity type:Organization
Organization Name:RAHWAY EDISON ORTHOPEDIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-381-2244
Mailing Address - Street 1:867 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2658
Mailing Address - Country:US
Mailing Address - Phone:732-381-2244
Mailing Address - Fax:732-388-7911
Practice Address - Street 1:867 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2658
Practice Address - Country:US
Practice Address - Phone:732-381-2244
Practice Address - Fax:732-388-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2603306Medicaid
NJ2603306Medicaid
NJ074640Medicare ID - Type UnspecifiedGROUP NUMBER