Healthcare Provider Details

I. General information

NPI: 1760683395
Provider Name (Legal Business Name): RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 WEST BALTIMORE PIKE SUITE 302
MEDIA PA
19063-5139
US

IV. Provider business mailing address

1118 WEST BALTIMORE PIKE SUITE 302
MEDIA PA
19063-5139
US

V. Phone/Fax

Practice location:
  • Phone: 610-480-6040
  • Fax: 610-480-6045
Mailing address:
  • Phone: 610-480-6040
  • Fax: 610-480-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E. WEST
Title or Position: CEO
Credential:
Phone: 267-339-3680