Provider Demographics
NPI:1326612045
Name:SUNNYVALE ORTHOPAEDIC AND REHABILITATION CLINIC LLC
Entity Type:Organization
Organization Name:SUNNYVALE ORTHOPAEDIC AND REHABILITATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANULI
Authorized Official - Middle Name:
Authorized Official - Last Name:MKPARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, MSC
Authorized Official - Phone:215-608-8937
Mailing Address - Street 1:2340 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4433
Mailing Address - Country:US
Mailing Address - Phone:215-608-8937
Mailing Address - Fax:267-459-5831
Practice Address - Street 1:2340 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4433
Practice Address - Country:US
Practice Address - Phone:215-608-8937
Practice Address - Fax:267-459-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty