Provider Demographics
NPI:1558399832
Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II PC
Entity Type:Organization
Organization Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II PC
Other - Org Name:ROTHMAN INSTITUTE PODIATRY PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-339-3680
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:267-339-3500
Mailing Address - Fax:215-503-0580
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:267-339-3500
Practice Address - Fax:215-503-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA171384Medicare ID - Type Unspecified