Basic Information
| Provider Information | |||||||||
| NPI: | 1912250267 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 931 E HAVERFORD RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105277870 | ||||||||
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| Practice Location | |||||||||
| Address1: | 931 E HAVERFORD RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105277870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2012 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | MALUMED | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6105219996 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.