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General NPI Number Information
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NPI Number | 1528118791
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Entity Type | Organization
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Legal Business Name | SOUTHERN NEW HAMPSHIRE SPORTS MEDICINE AND ORTHOPAEDIC CLINIC, P.A.
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 3 WINDHAM RD
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City | DERRY
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State | NH
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Zip | 03038-4275
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Country | US
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Telephone | 603-432-0590
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Fax | 603-432-2193
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Provider Business Mailing Address
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Address Line | 3 WINDHAM RD
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City | DERRY
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State | NH
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Zip | 03038-4275
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Country | US
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Telephone | 603-432-0590
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Fax | 603-432-2193
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JONATHAN W SOBEL
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Credential | MD
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Telephone | 603-432-0590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 7103
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License Number State | NH
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