Provider Demographics
NPI:1487494480
Name:MCCULLOCH ORTHOPAEDIC SURGICAL SERVICES OF NJ LLC
Entity type:Organization
Organization Name:MCCULLOCH ORTHOPAEDIC SURGICAL SERVICES OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-645-3899
Mailing Address - Street 1:520 FRANKLIN AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5815
Mailing Address - Country:US
Mailing Address - Phone:212-355-5555
Mailing Address - Fax:877-992-0798
Practice Address - Street 1:801 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2810
Practice Address - Country:US
Practice Address - Phone:212-355-5555
Practice Address - Fax:877-992-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty