1912307992 NPI number — PRESQUE ISLE ORTHOTICS AND PROSTHETICS OF OHIO, LLC

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 1912307992 NPI number — PRESQUE ISLE ORTHOTICS AND PROSTHETICS OF OHIO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESQUE ISLE ORTHOTICS AND PROSTHETICS OF OHIO, LLC
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:
PRESQUE ISLE MEDICAL TECHNOLOGIES
Provider Other Organization Name Type Code:
3
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:
1912307992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14055 CEDAR RD STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH EUCLID
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44118-3333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-371-0660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 OAKTON ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-432-7616
Provider Business Practice Location Address Fax Number:
773-432-7616
Provider Enumeration Date:
08/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HEIFETZ
Authorized Official First Name:
SOLOMON
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
216-371-0660

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)





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