1629323944 NPI number — NEW ENGLAND ORTHOTIC & PROSTHETIC SYSTEMS, 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 1629323944 NPI number — NEW ENGLAND ORTHOTIC & PROSTHETIC SYSTEMS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND ORTHOTIC & PROSTHETIC SYSTEMS, 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:
1629323944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 COMMERCIAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06405-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-483-8488
Provider Business Mailing Address Fax Number:
203-483-6085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 SALEM TURNPIKE
Provider Second Line Business Practice Location Address:
GREAT PLAINS PLAZA
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-6484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-887-2499
Provider Business Practice Location Address Fax Number:
860-887-2449
Provider Enumeration Date:
07/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MEYERS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
203-483-8488

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008048998 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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