NPIMap

Organization Active NPI

Orthopaedic Sports Medicine and Rehabilitation Center, LLC

Doing business as Orthopaedic Sports Medicine and Rehabilitation Center, P.A.

  • Orthopaedic Surgery Physician
  • Eatontown, NJ
National Provider Identifier
1821774076
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPAEDIC SPORTS MEDICINE AND REHABILITATION CENTER, LLC
Doing business as
Orthopaedic Sports Medicine and Rehabilitation Center, P.A.
Practice address
2-12 Corbett Way
Eatontown, NJ 07724-4251
Phone
(848) 257-1800
Fax
(848) 257-1155
NPI assigned
Jun 23, 2023
Last updated
Jan 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Authorized official

Name
James Dwyer
Title
Chief Financial Officer
Phone
(732) 741-2313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

2-12 Corbett Way
Eatontown, NJ 07724-4251

Mailing address

2-12 Corbett Way
Eatontown, NJ 07724-4251
Phone (848) 257-1800

Other names 1

  • Orthopaedic Sports Medicine and Rehabilitation Center, P.A. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240416002024 NJ DME Supplier - Physician - Orthopedic/Orthopedic Surgery 8022906056 Practice locations: Eatontown, NJ

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ortho Sports Medc Rehab3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

25 Kilmer Dr
Ste 104
Morganville, NJ 07751
Phone (732) 617-9111

80 Oak Hill Rd
Red Bank, NJ 07701
Phone (732) 741-2313

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736121600000",
    "number": "1821774076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2-12 CORBETT WAY",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077244251",
            "telephone_number": "848-257-1800",
            "fax_number": "848-257-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2-12 CORBETT WAY",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077244251",
            "telephone_number": "848-257-1800",
            "fax_number": "848-257-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDIC SPORTS MEDICINE AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-23",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "732-741-2313"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthopaedic Sports Medicine and Rehabilitation Center, P.A.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthopaedic Sports Medicine and Rehabilitation Center, P.A.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eatontown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.