Provider Demographics
NPI:1568534758
Name:ORTHOPEDIC RECONSTRUCTION SPECIALISTS LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC RECONSTRUCTION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-795-1945
Mailing Address - Street 1:600 SOMERDALE RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-795-1945
Mailing Address - Fax:856-795-7472
Practice Address - Street 1:600 SOMERDALE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-795-1945
Practice Address - Fax:856-795-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2218550OtherAETNA
747998OtherPA BLUE SHIELD
0546486000OtherAMERIHEALTH
1146556OtherHORIZON NJ HEALTH
0546486000OtherAMERIHEALTH
0546486000OtherAMERIHEALTH