Provider Demographics
NPI:1932708492
Name:SUNNYVALE ORTHOPAEDIC AND REHABILITATION CLINIC LLC
Entity Type:Organization
Organization Name:SUNNYVALE ORTHOPAEDIC AND REHABILITATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANULI
Authorized Official - Middle Name:
Authorized Official - Last Name:MKPARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-546-6446
Mailing Address - Street 1:200 MCKNIGHT PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6507
Mailing Address - Country:US
Mailing Address - Phone:412-348-0192
Mailing Address - Fax:
Practice Address - Street 1:2340 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4433
Practice Address - Country:US
Practice Address - Phone:215-770-4024
Practice Address - Fax:267-459-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-25
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103667850-0001Medicaid