Organization
CENTRAL JERSEY SPORTS MEDICINE & ORTHOPAEDIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW HARRISON M.D. (PRESIDENT)
(732) 905-8153
Entity
Organization
Contact information
Practice address
101 PROSPECT ST, SUITE 107, LAKEWOOD, NJ 08701-5020
(732) 905-8153
Mailing address
101 PROSPECT ST, SUITE 107, LAKEWOOD, NJ 08701-5020
(732) 905-8153
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
25MA06286400
NJ
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
25MA06286400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101389
—
NJ
01
—
200025845
RAILROAD MEDICARE
NJ
01
—
6009584
GHI
NJ
Enumeration date
04/17/2008
Last updated
07/28/2008
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