Provider Demographics
NPI:1124398235
Name:ORTHONORCAL, INC.
Entity Type:Organization
Organization Name:ORTHONORCAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS -PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-412-8100
Mailing Address - Street 1:340 DARDANELLI LN STE 10
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-412-8100
Mailing Address - Fax:408-412-8499
Practice Address - Street 1:340 DARDANELLI LN STE 10
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1418
Practice Address - Country:US
Practice Address - Phone:408-412-8100
Practice Address - Fax:408-369-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75584207X00000X
CA207X00000X
207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75584OtherDR. COHEN MEDICARE
CA6740500001OtherPTAN - DME
CAFY744AOtherMEDICARE PTAN