1093958985 NPI number — SUBURBAN ORTHOPAEDIC TOTAL JOINT AND SPORTS CLINIC, P.C.

Table of content: (NPI 1093958985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093958985 NPI number — SUBURBAN ORTHOPAEDIC TOTAL JOINT AND SPORTS CLINIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUBURBAN ORTHOPAEDIC TOTAL JOINT AND SPORTS CLINIC, 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:
Provider Other Organization Name Type Code:
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:
1093958985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11701 LIVINGSTON RD
Provider Second Line Business Mailing Address:
SUITE #105
Provider Business Mailing Address City Name:
FORT WASHINGTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20744-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-292-7440
Provider Business Mailing Address Fax Number:
301-292-3278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10905 FORT WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE #301
Provider Business Practice Location Address City Name:
FORT WASHINGTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20744-5843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-292-7440
Provider Business Practice Location Address Fax Number:
301-292-3278
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AZER
Authorized Official First Name:
SAMIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-292-7440

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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