Provider Demographics
NPI:1316411929
Name:ORTHOPEDIC CARE PHYSICIAN NETWORK LLC PLYMOUTH
Entity Type:Organization
Organization Name:ORTHOPEDIC CARE PHYSICIAN NETWORK LLC PLYMOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-746-5220
Mailing Address - Street 1:15 ROCHE BROTHERS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 WATER ST STE C105
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4062
Practice Address - Country:US
Practice Address - Phone:508-746-5220
Practice Address - Fax:508-746-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty