Provider Demographics
NPI:1679646905
Name:ADVANCED HAND ORTHOPEDIC & SPORTS MEDICINE CENTER, L.L.C.
Entity Type:Organization
Organization Name:ADVANCED HAND ORTHOPEDIC & SPORTS MEDICINE CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRIMIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-424-5180
Mailing Address - Street 1:447 OFFICE PLAZA
Mailing Address - Street 2:500 PLAZA COURT, STE D
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-424-5180
Mailing Address - Fax:570-421-8432
Practice Address - Street 1:447 OFFICE PLAZA
Practice Address - Street 2:500 PLAZA COURT, STE D
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-424-5180
Practice Address - Fax:570-421-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112252Medicare PIN