NPIMap

Organization Active NPI

Reconstructive Orthopedics, PA

  • Orthopaedic Surgery Physician
  • Marlton, NJ
National Provider Identifier
1659319002
Registry record updated Nov 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
RECONSTRUCTIVE ORTHOPEDICS, PA
Practice address
4 Eves Dr # a
Suite 100
Marlton, NJ 08053-3195
Phone
(609) 267-9400
NPI assigned
Jun 4, 2006
Last updated
Nov 12, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Amy Mickle
Title
Credentialing Specialist
Phone
(609) 267-9400

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X NJ Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

4 Eves Dr # a
Suite 100
Marlton, NJ 08053-3195

Mailing address

4 Eves Dr # a
Suite 100
Marlton, NJ 08053-3195
Phone (609) 267-9400

Other identifiers 1

IdentifierTypeStateIssuer
35052OtherNJAETNA ID NUMBER

National Provider Directory

National Provider Directory

Locations

243 US Highway 130
Bordentown, NJ 08505
Phone (609) 400-1630

4 Eves Dr
Ste 100
Marlton, NJ 08053

401 Young Ave
Ste 185
Moorestown, NJ 08057

401 Young Ave
Ste 245
Moorestown, NJ 08057
Phone (800) 896-7326

614 Lambs Rd
Ste C4
Pitman, NJ 08071

570 Egg Harbor Rd
Ste C
Sewell, NJ 08080

200 Bowman Dr
Ste 100
Voorhees, NJ 08043

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415750400000",
    "number": "1659319002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 EVES DR # A",
            "address_2": "SUITE 100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533195",
            "telephone_number": "609-267-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 EVES DR # A",
            "address_2": "SUITE 100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533195",
            "telephone_number": "609-267-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECONSTRUCTIVE ORTHOPEDICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2014-11-12",
        "status": "A",
        "authorized_official_last_name": "MICKLE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "609-267-9400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "NJ",
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID NUMBER",
            "identifier": "35052",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.