1215067756 NPI number — CARE CRAFTERS PROSTHETICS & ORTHOTICS, INC

Table of content: (NPI 1215067756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215067756 NPI number — CARE CRAFTERS PROSTHETICS & ORTHOTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE CRAFTERS PROSTHETICS & ORTHOTICS, 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:
1215067756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 NEW CLARKSTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-5203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-426-6900
Provider Business Mailing Address Fax Number:
845-426-6926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 NEW CLARKSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-426-6900
Provider Business Practice Location Address Fax Number:
845-426-6926
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DRYGAS
Authorized Official First Name:
THADDEUS
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-426-6900

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X , with the licence number:  45PO00013300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X , with the licence number: 45PO00013300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VION3P0506 . This is a "VETERANS ADMINISTRATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8586501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9602046 . This is a "GHI PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A398916 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01703433 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288276 . This is a "WELLCARE PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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