Basic Information
| Provider Information | |||||||||
| NPI: | 1780709717 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY ORTHOPEDICS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 OVERLOOK RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082738340 | ||||||||
| FaxNumber: | 9082731553 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 OVERLOOK RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082738340 | ||||||||
| FaxNumber: | 9082731553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ALTONGY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9082738340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XP3100X | MA048142 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1914502 | 05 | NJ | MEDICAID |