1629283452 NPI number — ORTHO MEDICAL PRODUCTS, INC.

Table of content: (NPI 1629283452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629283452 NPI number — ORTHO MEDICAL PRODUCTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHO MEDICAL PRODUCTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629283452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 JERICHO TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-746-0556
Provider Business Mailing Address Fax Number:
516-741-4738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 SARATOGA ROAD
Provider Second Line Business Practice Location Address:
BUILDING 2 UNIT 6
Provider Business Practice Location Address City Name:
SCOTIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12302-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-746-0556
Provider Business Practice Location Address Fax Number:
518-631-0026
Provider Enumeration Date:
05/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILDE
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-746-0556

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01988081 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".