1316501281 NPI number — FIRST STATE ORTHOPAEDICS, PA

Table of content: (NPI 1316501281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316501281 NPI number — FIRST STATE ORTHOPAEDICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STATE ORTHOPAEDICS, PA
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:
ORTHOPAEDIC ASSOCIATES OF SOUTHERN DELAWARE, PA
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:
1316501281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 EXECUTIVE DR STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-731-2888
Provider Business Mailing Address Fax Number:
302-731-7049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 ATLANTIC AVE STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN VIEW
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19970-9163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-3311
Provider Business Practice Location Address Fax Number:
302-644-3300
Provider Enumeration Date:
04/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BLAEUER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
302-731-2888

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1184681488 . This is a "COMMERCIAL INSURANCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0595270033 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".




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