Provider Demographics
NPI:1871902544
Name:NORTHEAST ORTHOPEDICS & SPORTS MEDICINE PLLC
Entity type:Organization
Organization Name:NORTHEAST ORTHOPEDICS & SPORTS MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-359-1877
Mailing Address - Street 1:99 DUTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2185
Mailing Address - Country:US
Mailing Address - Phone:845-359-1877
Mailing Address - Fax:845-262-5313
Practice Address - Street 1:99 DUTCH HILL RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2185
Practice Address - Country:US
Practice Address - Phone:845-359-1877
Practice Address - Fax:845-262-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty