Provider Demographics
NPI:1942472121
Name:PHALANX ORTHOPEDIC REAL ESTATE
Entity Type:Organization
Organization Name:PHALANX ORTHOPEDIC REAL ESTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARRERO-ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:7877-253-5555
Mailing Address - Street 1:PO BOX 19297
Mailing Address - Street 2:FERNANDEZ JUNCOS STA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1297
Mailing Address - Country:US
Mailing Address - Phone:787-725-3555
Mailing Address - Fax:787-723-6866
Practice Address - Street 1:AVE PONCE DE LEON # 1507
Practice Address - Street 2:PDA 22
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-3380
Practice Address - Country:US
Practice Address - Phone:787-725-3555
Practice Address - Fax:787-723-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9861261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center