1457319055 NPI number — NORPRO PROSTHETICS AND ORTHOTICS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457319055 NPI number — NORPRO PROSTHETICS AND ORTHOTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORPRO PROSTHETICS AND 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:
1457319055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 HIATT DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33418-7162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-627-7727
Provider Business Mailing Address Fax Number:
561-627-7727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 W NEW HAVEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
W MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32904-4056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-724-1877
Provider Business Practice Location Address Fax Number:
321-724-1936
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MINOR
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
561-627-7727

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 950605501 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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