1508840141 NPI number — CHOICE LIMB & BRACE

Table of content: (NPI 1508840141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508840141 NPI number — CHOICE LIMB & BRACE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICE LIMB & BRACE
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:
1508840141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555A S COLUMBUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10550-4731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-479-0743
Provider Business Mailing Address Fax Number:
914-479-1568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555A S COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10550-4731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-479-0743
Provider Business Practice Location Address Fax Number:
914-479-1568
Provider Enumeration Date:
12/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SQUICCIARINI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CPO CRED
Authorized Official Telephone Number:
914-479-0743

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  1230265 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 412358224 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A2540663 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02215167 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".