=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790957751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ORTHOPEDIC SURGERY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2008
-----------------------------------------------------
Last Update Date | 07/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 N BROADWAY SUITE 510
-----------------------------------------------------
City | SLEEPY HOLLOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10591-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-631-1142
-----------------------------------------------------
Fax | 914-631-1715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 N BROADWAY SUITE 510
-----------------------------------------------------
City | SLEEPY HOLLOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10591-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-631-1142
-----------------------------------------------------
Fax | 914-631-1715
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RALPH NORMAN PURCELL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 914-631-1142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 162493
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------