1881911436 NPI number — KEYSTONE ORTHOPAEDIC SPECIALISTS

Table of content: MRS. SUZANNE ROBERTSON MILLER M.A., CRC (NPI 1447477559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881911436 NPI number — KEYSTONE ORTHOPAEDIC SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE ORTHOPAEDIC SPECIALISTS
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:
1881911436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 LEE RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-5650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-321-5412
Provider Business Mailing Address Fax Number:
610-687-0197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 PENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SINKING SPRING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19608-9670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-898-0674
Provider Business Practice Location Address Fax Number:
610-898-0861
Provider Enumeration Date:
04/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
REES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
B
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
610-376-8671

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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