Provider Demographics
NPI:1174621015
Name:TOTAL ORTHOPAEDICS AND SPORTS MEDICINE, LLP
Entity type:Organization
Organization Name:TOTAL ORTHOPAEDICS AND SPORTS MEDICINE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-795-3033
Mailing Address - Street 1:5500 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6216
Mailing Address - Country:US
Mailing Address - Phone:516-795-3033
Mailing Address - Fax:
Practice Address - Street 1:5500 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6216
Practice Address - Country:US
Practice Address - Phone:516-795-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6242450001Medicare NSC
NYWKB861Medicare ID - Type Unspecified