Provider Demographics
NPI:1285833236
Name:ORTHOPEDIC CENTER OF NEW ENGLAND PA
Entity Type:Organization
Organization Name:ORTHOPEDIC CENTER OF NEW ENGLAND PA
Other - Org Name:BACK COVE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PADAVANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-773-7428
Mailing Address - Street 1:55 BAXTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1801
Mailing Address - Country:US
Mailing Address - Phone:207-773-7428
Mailing Address - Fax:207-842-6229
Practice Address - Street 1:55 BAXTER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1801
Practice Address - Country:US
Practice Address - Phone:207-773-7428
Practice Address - Fax:207-842-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1071207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007124Medicare UPIN
1135770001Medicare NSC
MM2605Medicare UPIN