Provider Demographics
NPI:1861457087
Name:DELAWARE VALLEY ORTHOPAEDIC ASSOC LTD.
Entity Type:Organization
Organization Name:DELAWARE VALLEY ORTHOPAEDIC ASSOC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-331-6050
Mailing Address - Street 1:9140 ACADEMY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2853
Mailing Address - Country:US
Mailing Address - Phone:215-331-6050
Mailing Address - Fax:215-331-6055
Practice Address - Street 1:9140 ACADEMY RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2853
Practice Address - Country:US
Practice Address - Phone:215-331-6050
Practice Address - Fax:215-331-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037952OtherBS
PA489363OtherAETNA/USHC
PA0052320000OtherKEYSTONE
PA037952OtherBS
PA037952Medicare ID - Type Unspecified