Provider Demographics
NPI:1902973654
Name:ADVANCED ORTHOPAEDIC & JOINT REPLACEMENT CENTER PA
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC & JOINT REPLACEMENT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-736-9980
Mailing Address - Street 1:741 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1174
Mailing Address - Country:US
Mailing Address - Phone:973-736-9980
Mailing Address - Fax:973-736-9981
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-736-9980
Practice Address - Fax:973-736-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36729174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6398720001OtherPTAN NUMBER
NJ6398720001Medicare NSC