Healthcare Provider Details

I. General information

NPI: 1356549273
Provider Name (Legal Business Name): VALLEY ORTHOPEDIC SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOISEY DRIVE SUITE 202
HAZLETON PA
18222
US

IV. Provider business mailing address

50 MOISEY DRIVE SUITE 202
HAZLETON PA
18222
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-9522
  • Fax: 570-501-9413
Mailing address:
  • Phone: 570-501-9522
  • Fax: 570-501-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD042042E
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. MARK NICHOLAS PERLMUTTER
Title or Position: SURGEON
Credential: M.D.
Phone: 570-501-9522