Provider Demographics
NPI:1871233452
Name:ORTHOPAEDICS SPINE AND SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:ORTHOPAEDICS SPINE AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RUOTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-795-3033
Mailing Address - Street 1:115 EILEEN WAY
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5302
Mailing Address - Country:US
Mailing Address - Phone:516-795-3033
Mailing Address - Fax:
Practice Address - Street 1:2339 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2038
Practice Address - Country:US
Practice Address - Phone:516-795-3033
Practice Address - Fax:516-590-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies