# BOARD CERTIFIED ORTHOPEDIC SURGICAL SPECILISTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BOARD CERTIFIED ORTHOPEDIC SURGICAL SPECILISTS LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154152338
- **Authorized official:** TIMOTHY HENDERSON MD (OWNER)
- **Authorized official phone:** (404) 387-0092

## Contact information

- **Practice address:** 2165 JONES RD, FORT LEE, NJ 07024-3202
- **Practice address phone:** (404) 387-0092
- **Mailing address:** 2165 JONES RD, FORT LEE, NJ 07024-3202
- **Mailing address phone:** (404) 387-0092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | NULL | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | — | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 08/09/2024
- **Last updated:** 10/16/2024