Healthcare Provider Details

I. General information

NPI: 1437324761
Provider Name (Legal Business Name): VSAS ORTHOPAEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CEDAR CREST BLVD SUITE 110
ALLENTOWN PA
18103-6224
US

IV. Provider business mailing address

1250 S CEDAR CREST BLVD SUITE 110
ALLENTOWN PA
18103-6224
US

V. Phone/Fax

Practice location:
  • Phone: 610-435-1003
  • Fax: 610-435-3184
Mailing address:
  • Phone: 610-435-1003
  • Fax: 610-435-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC006644L
License Number StatePA

VIII. Authorized Official

Name: ANDREW PROKURAT
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 610-435-1003