Provider Demographics
NPI:1215053699
Name:RIDGEWOOD ORTHOPAEDIC SPECIALISTS
Entity type:Organization
Organization Name:RIDGEWOOD ORTHOPAEDIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GRABIAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-375-6226
Mailing Address - Street 1:2201 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1189
Mailing Address - Country:US
Mailing Address - Phone:610-375-6226
Mailing Address - Fax:610-375-6200
Practice Address - Street 1:2201 RIDGEWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1189
Practice Address - Country:US
Practice Address - Phone:610-375-6226
Practice Address - Fax:610-375-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012376E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB77279Medicare UPIN
PAGR134157Medicare ID - Type Unspecified