Provider Demographics
NPI:1720120108
Name:ORTHO-PEDO ASSOCIATES, PA
Entity Type:Organization
Organization Name:ORTHO-PEDO ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMTRAUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-502-4366
Mailing Address - Street 1:987 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7048
Mailing Address - Country:US
Mailing Address - Phone:954-753-4005
Mailing Address - Fax:
Practice Address - Street 1:987 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7048
Practice Address - Country:US
Practice Address - Phone:954-753-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental