Healthcare Provider Details

I. General information

NPI: 1457623688
Provider Name (Legal Business Name): FALVELLO ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 N CHURCH ST
HAZLETON PA
18202-1465
US

IV. Provider business mailing address

PO BOX 87
HAZLETON PA
18201-0087
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8080
  • Fax: 610-861-0854
Mailing address:
  • Phone: 610-861-8080
  • Fax: 610-861-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS015140
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANTHONY C FALVELLO
Title or Position: OWNER
Credential: MD
Phone: 610-861-8080