Provider Demographics
NPI:1659571461
Name:NORTH SHORE ORTHOPEDICS INC
Entity Type:Organization
Organization Name:NORTH SHORE ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-357-8358
Mailing Address - Street 1:1962 E VINEYARD ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1715
Mailing Address - Country:US
Mailing Address - Phone:808-357-8358
Mailing Address - Fax:
Practice Address - Street 1:1827 WELLS ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2370
Practice Address - Country:US
Practice Address - Phone:808-242-0001
Practice Address - Fax:808-244-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD86402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH0000BDWCNMedicare PIN