Basic Information
| Provider Information | |||||||||
| NPI: | 1487677498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONVALE ORTHOPEDICS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 PLAZA DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | ROSTRAVER TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150124019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243795802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 PLAZA DR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | BELLE VERNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150124019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243795816 | ||||||||
| FaxNumber: | 7243795874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 06/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | FERGUSON | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7243795802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0011318300010 | 05 | PA | MEDICAID | 150719 | 01 | PA | HIGHMARK BC BS | OTHER |