1306539077 NPI number — DYNAMIC ORTHOPEDICS OF NEW YORK, PLLC

Table of content: (NPI 1306539077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306539077 NPI number — DYNAMIC ORTHOPEDICS OF NEW YORK, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC ORTHOPEDICS OF NEW YORK, PLLC
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:
1306539077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 773574
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33077-3574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-688-6884
Provider Business Mailing Address Fax Number:
954-656-5206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 WATERS PL STE 903
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-2733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-688-6884
Provider Business Practice Location Address Fax Number:
954-656-5206
Provider Enumeration Date:
05/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HESS
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-688-6884

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com