1982697181 NPI number — INNOVATIVE ORTHOTICS & PROSTHETICS

Table of content: EDWARD MICHAEL LEWIECKI M.D. (NPI 1861441735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982697181 NPI number — INNOVATIVE ORTHOTICS & PROSTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE ORTHOTICS & PROSTHETICS
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:
1982697181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 PALISADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10607-2716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-592-6359
Provider Business Mailing Address Fax Number:
914-592-0143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 PALISADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10607-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-592-6359
Provider Business Practice Location Address Fax Number:
914-592-0143
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHALANT
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PROSTHETIST
Authorized Official Telephone Number:
914-592-6359

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: 01018717 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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