Healthcare Provider Details

I. General information

NPI: 1306354311
Provider Name (Legal Business Name): PRISK ORTHOPAEDICS AND WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 06/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 MOSSIDE BLVD
MONROEVILLE PA
15146-4236
US

IV. Provider business mailing address

2490 MOSSIDE BLVD
MONROEVILLE PA
15146-4236
US

V. Phone/Fax

Practice location:
  • Phone: 412-525-7692
  • Fax: 412-646-1995
Mailing address:
  • Phone: 412-525-7692
  • Fax: 412-646-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VICTOR ROBERT PRISK
Title or Position: OWNER
Credential: MD
Phone: 412-525-7692