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Organization
RECONSTRUCTIVE ORTHOPEDICS, P.A.
Active
Organization
RECONSTRUCTIVE ORTHOPEDICS, P.A.
Active
Parent organization
RECONSTRUCTIVE ORTHOPEDICS, P.A,
Organization subpart
Yes
Provider details
NPI number
Legal business name
RECONSTRUCTIVE ORTHOPEDICS, P.A,
Authorized official
AMY MICKLE (CREDENTIALING SPECIALIST)
(609) 267-9400
Entity
Organization
Contact information
Practice address
994 W SHERMAN AVE, BUILDING 1, VINELAND, NJ 08360-6937
(856) 696-0900
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
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
NULL
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
11/12/2014
Last updated
11/12/2014
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