Healthcare Provider Details

I. General information

NPI: 1255515375
Provider Name (Legal Business Name): SLRHC FACULTY PRACTICE - ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

PO BOX 95000-2881 ORTHO PA GROUP
PHILADELPHIA PA
19195-2881
US

V. Phone/Fax

Practice location:
  • Phone: 212-636-3800
  • Fax: 212-523-7575
Mailing address:
  • Phone: 212-308-1112
  • Fax: 212-308-1616

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 Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RAUL AGUILAR
Title or Position: BILLING DIRECTOR
Credential:
Phone: 212-308-1112