1487608311 NPI number — MODERN LIMB & BRACE CO.

Table of content: (NPI 1487608311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487608311 NPI number — MODERN LIMB & BRACE CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MODERN LIMB & BRACE CO.
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:
1487608311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 SOMERSET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATCHUNG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07069-6305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-757-2702
Provider Business Mailing Address Fax Number:
908-757-0744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 SOMERSET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATCHUNG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07069-6305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-757-2702
Provider Business Practice Location Address Fax Number:
908-757-0744
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OERTEL
Authorized Official First Name:
HORST
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
908-757-2702

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: 2758 . This is a "LIBERTY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 555663 . This is a "PMSI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0003963000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: SO000006600 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K1884 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 040045 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 10540304 . This is a "GUARDIAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2784203 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1066390 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1487608311 . This is a "HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 260248900 . This is a "ACS - US DEPT LABOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 260248900 . This is a "STATE OF NJ - WORKERS COMP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A522677 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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