# RECONSTRUCTIVE ORTHOPEDICS, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RECONSTRUCTIVE ORTHOPEDICS, P.A,
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679979090
- **Legal business name:** RECONSTRUCTIVE ORTHOPEDICS, P.A,
- **Authorized official:** AMY MICKLE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (609) 267-9400

## Contact information

- **Practice address:** 994 W SHERMAN AVE, BUILDING 1, VINELAND, NJ 08360-6937
- **Practice address phone:** (856) 696-0900
- **Mailing address:** 4 EVES DR \# A, SUITE 100, MARLTON, NJ 08053-3195
- **Mailing address phone:** (609) 267-9400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 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