Provider Demographics
NPI:1346387560
Name:HERITAGE PARK ORTHOPEDICS
Entity Type:Organization
Organization Name:HERITAGE PARK ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONFORTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-452-9914
Mailing Address - Street 1:817 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3571
Mailing Address - Country:US
Mailing Address - Phone:978-452-9914
Mailing Address - Fax:978-453-0069
Practice Address - Street 1:817 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3571
Practice Address - Country:US
Practice Address - Phone:978-452-9914
Practice Address - Fax:978-453-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35426207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9769692Medicaid
MA9769692Medicaid
MAM13841Medicare ID - Type Unspecified