Provider Demographics
NPI:1891905642
Name:ISLAND ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:ISLAND ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-714-5400
Mailing Address - Street 1:PO BOX 503030
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00805-3030
Mailing Address - Country:US
Mailing Address - Phone:340-714-5400
Mailing Address - Fax:
Practice Address - Street 1:9154 ESTATE THOMAS
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2687
Practice Address - Country:US
Practice Address - Phone:340-714-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1376207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1376OtherMEDICAL LICENSE
VI1004285OtherOFFICE OF HEALTH PRACTITI