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SPECIALTY ORTHOPAEDICS OF NEW JERSEY PA NPI 1174580807


NPI Information

NPI: 1174580807
Provider Name: SPECIALTY ORTHOPAEDICS OF NEW JERSEY, PA

Former Legal Business Name: EDWARD B SELF JR MD FACS PA

Classification: Specialist - 174400000X
Entity Type: Organization
Address:
1124 E RIDGEWOOD AVE
201
RIDGEWOOD, NJ
ZIP 07450
Phone: (201) 447-1188
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SPECIALTY ORTHOPAEDICS OF NEW JERSEY, PA is a specialist in Ridgewood, NJ. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SPECIALTY ORTHOPAEDICS OF NEW JERSEY, PA NPI is 1174580807. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Edward B Self Jr Md Facs Pa.

The provider's business location address is:

1124 E RIDGEWOOD AVE
201
RIDGEWOOD, NJ
ZIP 07450-915
Phone: (201) 447-1188
Fax: (201) 447-8935

The provider's authorized official is David P Rudman .
The authorized official title is President and has the following contact phone number (201) 447-1188.

The enumeration date for this NPI number is 4/27/2006 and was last updated on 10/7/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist25MA07771200NEW JERSEYNo
2174400000XSpecialistMA33233NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1085563OTHERNEW JERSEYSPECIALTY ORTHOPAEDICS
2167796MEDICARE ID-TYPE UNSPECIFIEDNEW JERSEYEDWARD B. SELF, JR., M.D.
3085565TGPMEDICARE ID-TYPE UNSPECIFIEDNEW JERSEYDAVID P. RUDMAN, M.D.
4H97642MEDICARE UPINNEW JERSEY
5D18650MEDICARE UPINNEW JERSEY
6085563MEDICARE PINNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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