Orthopedic Surgery & Sports Medicine Center, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

64376 Issued in NJ

Legal business name

ORTHOPEDIC SURGERY & SPORTS MEDICINE CENTER, LLC

Practice address

61 Beaverbrook Rd
Ste 201
Lincoln Park, NJ 07035-1748

Phone

(973) 616-0200

Fax

(973) 696-9294

NPI assigned

May 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jeannette Botero

Title

Office Manager

Phone

(973) 616-0200

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196985600000",
    "number": "1598712556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 BEAVERBROOK RD",
            "address_2": "STE 201",
            "city": "LINCOLN PARK",
            "state": "NJ",
            "postal_code": "070351748",
            "telephone_number": "973-616-0200",
            "fax_number": "973-696-9294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 BEAVERBROOK RD",
            "address_2": "STE 201",
            "city": "LINCOLN PARK",
            "state": "NJ",
            "postal_code": "070351748",
            "telephone_number": "973-616-0200",
            "fax_number": "973-696-9294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC SURGERY & SPORTS MEDICINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2007-12-07",
        "status": "A",
        "authorized_official_last_name": "BOTERO",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-616-0200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "43990",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "62817",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "64376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lincoln Park, NJ
• Providers in Lincoln Park, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.