Provider Demographics
NPI:1891024436
Name:SIDNEY HILLMAN ORTHO
Entity Type:Organization
Organization Name:SIDNEY HILLMAN ORTHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-568-4080
Mailing Address - Street 1:2116 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4401
Mailing Address - Country:US
Mailing Address - Phone:215-568-4080
Mailing Address - Fax:215-568-4088
Practice Address - Street 1:2116 CHESTNUT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4401
Practice Address - Country:US
Practice Address - Phone:215-568-4080
Practice Address - Fax:215-568-4088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIDNEY HILLMAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024995E261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA022113Medicare PIN