Healthcare Provider Details

I. General information

NPI: 1659780872
Provider Name (Legal Business Name): PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 JOHN YOUNG WAY SUITE 100
EXTON PA
19341-2567
US

IV. Provider business mailing address

491 JOHN YOUNG WAY SUITE 100
EXTON PA
19341-2567
US

V. Phone/Fax

Practice location:
  • Phone: 610-280-1586
  • Fax: 610-280-1560
Mailing address:
  • Phone: 610-280-1586
  • Fax: 610-280-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY MALUMED
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-359-5640