Healthcare Provider Details

I. General information

NPI: 1316479199
Provider Name (Legal Business Name): ISLAND ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2135 FORT WEAVER RD FL 4
EWA BEACH HI
96706-1940
US

IV. Provider business mailing address

3382 WAIALAE AVE
HONOLULU HI
96816-2637
US

V. Phone/Fax

Practice location:
  • Phone: 808-548-7033
  • Fax:
Mailing address:
  • Phone: 808-548-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateHI

VIII. Authorized Official

Name: ALEXANDER GARBER
Title or Position: MEMBER
Credential: MD
Phone: 808-548-7033