Provider Demographics
NPI:1225008659
Name:SUBURBAN ORTHOPAEDIC SPECIALISTS
Entity Type:Organization
Organization Name:SUBURBAN ORTHOPAEDIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNHERZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-355-7220
Mailing Address - Street 1:283 2ND STREET PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3823
Mailing Address - Country:US
Mailing Address - Phone:215-355-7220
Mailing Address - Fax:215-355-7222
Practice Address - Street 1:283 2ND STREET PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3823
Practice Address - Country:US
Practice Address - Phone:215-355-7220
Practice Address - Fax:215-355-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
478172OtherHIGHMARK BS
PACI8941OtherTRAVELERS MEDICARE
PA027321Medicare PIN
PA6377760001Medicare NSC