Provider Demographics
NPI:1770520322
Name:PARKSIDE ORTHOPEDIC ASSOCIATES
Entity type:Organization
Organization Name:PARKSIDE ORTHOPEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:H
Authorized Official - Last Name:BONIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-962-9622
Mailing Address - Street 1:1599 N HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3180
Mailing Address - Country:US
Mailing Address - Phone:724-962-9622
Mailing Address - Fax:724-962-6027
Practice Address - Street 1:1599 N HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3180
Practice Address - Country:US
Practice Address - Phone:724-962-9622
Practice Address - Fax:724-962-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0502594Medicaid
PA0008605210003Medicaid
CE1166Medicare PIN
OH0502594Medicaid
OH9262371Medicare PIN