Healthcare Provider Details

I. General information

NPI: 1689728669
Provider Name (Legal Business Name): ORTHOPEDIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MONTVALE AVE SUITE 1400
STONEHAM MA
02180-3647
US

IV. Provider business mailing address

92 MONTVALE AVE SUITE 1400
STONEHAM MA
02180-3647
US

V. Phone/Fax

Practice location:
  • Phone: 781-279-7040
  • Fax: 781-279-8430
Mailing address:
  • Phone: 781-279-7040
  • Fax: 781-279-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN STANTON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 781-279-7040