Provider Demographics
NPI:1871856476
Name:EMERGEORTHO, PA
Entity type:Organization
Organization Name:EMERGEORTHO, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAT, ATC
Authorized Official - Phone:603-662-7585
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 WILLIAM PENN PLZ
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2150
Practice Address - Country:US
Practice Address - Phone:919-220-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care