Provider Demographics
NPI:1841293859
Name:ATLANTIC ORTHOPAEDIC GROUP PA
Entity type:Organization
Organization Name:ATLANTIC ORTHOPAEDIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERMANSDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-768-9914
Mailing Address - Street 1:2222 S. HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-768-9914
Mailing Address - Fax:321-953-1893
Practice Address - Street 1:2222 S. HARBOR CITY BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-768-9914
Practice Address - Fax:321-953-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3777950001Medicare NSC
FL39175Medicare ID - Type Unspecified