Organization
NORTH JERSEY PEDIATRIC ORTHPEDICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS AVELLA MD (OWNER)
(201) 445-2457
Entity
Organization
Contact information
Practice address
140 CHESTNUT ST, SUITE 201, RIDGEWOOD, NJ 07450-2599
(210) 445-2457
(201) 445-9050
Mailing address
140 CHESTNUT ST, SUITE 201, RIDGEWOOD, NJ 07450-2599
(210) 445-2457
(201) 445-9050
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
MA39087
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1822900
—
NJ
05
—
3333604
—
NJ
01
—
3Q4361
BCBS
NJ
01
—
81D031
BCBS
NJ
05
—
9483401
—
NJ
Enumeration date
03/05/2007
Last updated
11/06/2007
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