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Organization
RECONSTRUCTIVE ORTHOPEDICS, PA
Active
Organization
RECONSTRUCTIVE ORTHOPEDICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY MICKLE (CREDENTIALING SPECIALIST)
(609) 267-9400
Entity
Organization
Contact information
Practice address
4 EVES DR # A, SUITE 100, MARLTON, NJ 08053-3195
(609) 267-9400
Mailing address
4 EVES DR # A, SUITE 100, MARLTON, NJ 08053-3195
(609) 267-9400
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NJ
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35052
AETNA ID NUMBER
NJ
Enumeration date
06/04/2006
Last updated
11/12/2014
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