Healthcare Provider Details

I. General information

NPI: 1033217443
Provider Name (Legal Business Name): ACADEMY ORTHOPEDICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 EGG HARBOR RD SUITE B2
SEWELL NJ
08080-2359
US

IV. Provider business mailing address

570 EGG HARBOR RD SUITE B2
SEWELL NJ
08080-2359
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-0051
  • Fax: 856-256-1903
Mailing address:
  • Phone: 856-256-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number46TR00116000
License Number StateNJ

VIII. Authorized Official

Name: FREDERICK L COLE
Title or Position: PHYSICIAN CORPORATE OFFICER
Credential: DO
Phone: 856-784-4444