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General NPI Number Information
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NPI Number | 1619556008
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Entity Type | Organization
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Legal Business Name | PREMIER ORTHOPAEDIC & SPORTS MEDICINE ASSO., LTD.
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 8815 GERMANTOWN AVE STE 14
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2722
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Country | US
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Telephone | 484-768-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 3809 W CHESTER PIKE STE 150
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-0259
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Country | US
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Telephone | 610-359-5691
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Fax | 610-359-1519
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY MALUMED
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Credential |
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Telephone | 610-521-8970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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