# CENTRAL JERSEY SPORTS MEDICINE & ORTHOPAEDIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710151014
- **Authorized official:** DR. ANDREW HARRISON M.D. (PRESIDENT)
- **Authorized official phone:** (732) 905-8153

## Contact information

- **Practice address:** 101 PROSPECT ST, SUITE 107, LAKEWOOD, NJ 08701-5020
- **Practice address phone:** (732) 905-8153
- **Mailing address:** 101 PROSPECT ST, SUITE 107, LAKEWOOD, NJ 08701-5020
- **Mailing address phone:** (732) 905-8153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 25MA06286400 | NJ | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | 25MA06286400 | NJ | — |

## Other

- **Enumeration date:** 04/17/2008
- **Last updated:** 07/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0101389 | — | NJ |
| 01 | — | 200025845 | RAILROAD MEDICARE | NJ |
| 01 | — | 6009584 | GHI | NJ |