Basic Information
| Provider Information | |||||||||
| NPI: | 1356385900 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL ORTHOPEDICS ASSOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 776 SHREWSBURY AVE | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327410665 | ||||||||
| FaxNumber: | 7327410668 | ||||||||
| Practice Location | |||||||||
| Address1: | 776 SHREWSBURY AVE | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327410665 | ||||||||
| FaxNumber: | 7327410668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADM | ||||||||
| AuthorizedOfficialTelephone: | 7327410665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.