Provider Demographics
NPI:1740481340
Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II, P.C.
Entity type:Organization
Organization Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-339-3680
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:267-339-3558
Mailing Address - Fax:267-339-3763
Practice Address - Street 1:234 MALL BLVD
Practice Address - Street 2:SUITE G-10, THE ATRIUM BUILDING
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2954
Practice Address - Country:US
Practice Address - Phone:610-755-3080
Practice Address - Fax:610-755-3110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0487840002Medicare NSC