Healthcare Provider Details

I. General information

NPI: 1255666012
Provider Name (Legal Business Name): KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 KEISER BLVD STE 200
WYOMISSING PA
19610-3326
US

IV. Provider business mailing address

2607 KEISER BLVD STE 200
WYOMISSING PA
19610-3326
US

V. Phone/Fax

Practice location:
  • Phone: 484-509-0840
  • Fax: 610-568-1036
Mailing address:
  • Phone: 484-509-0840
  • Fax: 610-568-1036

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 Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN P BANCO
Title or Position: PRESIDENT
Credential: MD
Phone: 484-509-0840