Healthcare Provider Details

I. General information

NPI: 1710269287
Provider Name (Legal Business Name): ORTHOCARIBBEAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ESTATE RUBY SUITE 1
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 1095
CHRISTIANSTED VI
00821-1095
US

V. Phone/Fax

Practice location:
  • Phone: 340-692-5000
  • Fax: 340-692-5002
Mailing address:
  • Phone: 340-692-5000
  • Fax: 340-692-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number1499
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number653
License Number StateVI
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1499
License Number StateVI
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number653
License Number StateVI

VIII. Authorized Official

Name: DANIEL VAN ALLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 340-692-5000