Healthcare Provider Details

I. General information

NPI: 1285146530
Provider Name (Legal Business Name): ORTHOPEDIC SURGERY & REHABILITATION ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 FOX CHASE RD
ROCKLEDGE PA
19046-4437
US

IV. Provider business mailing address

888 FOX CHASE RD
ROCKLEDGE PA
19046-4437
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-4050
  • Fax: 215-663-9388
Mailing address:
  • Phone: 215-745-4050
  • Fax: 215-663-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL WAGNER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 215-856-1114