Provider Demographics
NPI:1578001657
Name:ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE CENTER PC
Entity type:Organization
Organization Name:ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:KASIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-703-5097
Mailing Address - Street 1:1907 OAK TREE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1907 OAK TREE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2070
Practice Address - Country:US
Practice Address - Phone:732-548-7332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06620000332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site