Healthcare Provider Details

I. General information

NPI: 1073524260
Provider Name (Legal Business Name): ORTHOPEDIC AND NEUROSURGICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N HADDON AVE
HADDONFIELD NJ
08033-1749
US

IV. Provider business mailing address

807 N HADDON AVE
HADDONFIELD NJ
08033-1749
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-9222
  • Fax: 856-795-0126
Mailing address:
  • Phone: 856-795-9222
  • Fax: 856-795-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MB07645900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number25MA05226300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD041578E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA05917000
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD064219L
License Number StatePA

VIII. Authorized Official

Name: ROBERT M DALSEY
Title or Position: PHYSICIAN
Credential: MD
Phone: 856-795-9222