Provider Demographics
NPI:1609675156
Name:ORTHOEDGE2
Entity type:Organization
Organization Name:ORTHOEDGE2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:IDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-510-3723
Mailing Address - Street 1:470 JOHNSON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:470 JOHNSON RD STE 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8944
Practice Address - Country:US
Practice Address - Phone:412-206-6770
Practice Address - Fax:724-941-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty