Healthcare Provider Details

I. General information

NPI: 1649324195
Provider Name (Legal Business Name): RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST STE 1220
PHILADELPHIA PA
19107-4413
US

IV. Provider business mailing address

925 CHESTNUT ST 5TH FLOOR
PHILADELPHIA PA
19107-4216
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-9999
  • Fax: 267-479-1321
Mailing address:
  • Phone: 267-339-3500
  • Fax: 215-503-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLI HUBER
Title or Position: DIRECTOR OF BUSINESS OFFICE
Credential:
Phone: 267-338-3690