Healthcare Provider Details

I. General information

NPI: 1346548633
Provider Name (Legal Business Name): CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W MARYLAND AVE SUITE 2
PHOENIX AZ
85015-1740
US

IV. Provider business mailing address

3010 W AGUA FRIA FWY SUITE 100
PHOENIX AZ
85027-3943
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-5600
  • Fax: 866-939-2673
Mailing address:
  • Phone: 623-474-3498
  • Fax: 623-455-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. DAVID JACOFSKY
Title or Position: CHAIRMAN
Credential: MD
Phone: 623-537-5600