Provider Demographics
NPI:1265725824
Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES, II, P.C.
Entity type:Organization
Organization Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES, II, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-339-3680
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MOB EAST, SUITE 456
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-922-2112
Mailing Address - Fax:484-412-8497
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MOB EAST, SUITE 456
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-922-2112
Practice Address - Fax:484-412-8497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES, II, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-16
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier