Provider Demographics
NPI:1982721387
Name:ORTHOPEDIC CARE SPECIALISTS INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC CARE SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-344-3535
Mailing Address - Street 1:15 ROCHE BROS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1000
Mailing Address - Country:US
Mailing Address - Phone:781-344-3535
Mailing Address - Fax:781-573-1696
Practice Address - Street 1:20 ROCHE BROS WAY UNIT 1
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1030
Practice Address - Country:US
Practice Address - Phone:781-573-1686
Practice Address - Fax:781-573-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9702911Medicaid
MAY61349OtherBC BS GROUP PROVIDER #
MA602587OtherTUFTS GROUP PROVIDER #
MA0013738OtherNHP PT & OT PROVIDER #
MA626575OtherHPHC GROUP PROVIDER #
MAY61349OtherBC BS GROUP PROVIDER #