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General NPI Number Information
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NPI Number | 1750814976
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE AND JOINT REPLACEMENT SPECIALIST CORP
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 345 MOUNT LEBANON BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15234-1504
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Country | US
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Telephone | 412-207-9780
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Fax |
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Provider Business Mailing Address
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Address Line | 345 MOUNT LEBANON BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15234-1504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY HABIB
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Credential |
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Telephone | 412-207-9780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | OS013015
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License Number State | PA
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