1912001058 NPI number — RUGGIERO ORTHOPAEDIC ASSOCIATES LTD., P.C.

Table of content: (NPI 1912001058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912001058 NPI number — RUGGIERO ORTHOPAEDIC ASSOCIATES LTD., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUGGIERO ORTHOPAEDIC ASSOCIATES LTD., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED PODIATRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912001058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
266 LANCASTER AVE
Provider Second Line Business Mailing Address:
SUITE200
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-3256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-6900
Provider Business Mailing Address Fax Number:
610-644-7160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
266 LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MALVERN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19355-3256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-644-6900
Provider Business Practice Location Address Fax Number:
610-644-7160
Provider Enumeration Date:
09/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
JASON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SPECIALIST
Authorized Official Telephone Number:
610-644-6900

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC004466L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CC6125 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".