Provider Demographics
NPI:1962877225
Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II, LLC
Entity type:Organization
Organization Name:RECONSTRUCTIVE ORTHOPAEDIC ASSOCIATES II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-339-3500
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:609-677-7003
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:1200 MANOR DR
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2203
Practice Address - Country:US
Practice Address - Phone:215-830-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA171384Medicare PIN