Basic Information
| Provider Information | |||||||||
| NPI: | 1538271697 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACADEMY ORTHOPEDICS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 570 EGG HARBOR ROAD | ||||||||
| Address2: | SUITE B2 | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562560051 | ||||||||
| FaxNumber: | 8562561903 | ||||||||
| Practice Location | |||||||||
| Address1: | 570 EGG HARBOR RD | ||||||||
| Address2: | SUITE B2 | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562560051 | ||||||||
| FaxNumber: | 8562561903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | MARCELLI | ||||||||
| AuthorizedOfficialFirstName: | ENRICO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER CORPORATE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8562560051 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225XH1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.