1306377809 NPI number — PROSTHETIC AND ORTHOTIC DESIGNS, LLC

Table of content: (NPI 1306377809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306377809 NPI number — PROSTHETIC AND ORTHOTIC DESIGNS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSTHETIC AND ORTHOTIC DESIGNS, 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:
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:
1306377809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 CRYSTAL RUN RD STE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10941-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-703-8134
Provider Business Mailing Address Fax Number:
845-703-8135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 CRYSTAL RUN RD STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10941-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-703-8134
Provider Business Practice Location Address Fax Number:
845-703-8135
Provider Enumeration Date:
03/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HESS
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PROSTHETIST ORTHOTIST/PRESIDENT
Authorized Official Telephone Number:
845-480-4391

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  45PO00016200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com