1669472692 NPI number — LAWALL PROSTHETICS ORTHOTICS INC

Table of content: (NPI 1669472692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669472692 NPI number — LAWALL PROSTHETICS ORTHOTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWALL PROSTHETICS ORTHOTICS INC
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:
1669472692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 CABOT BLVD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-338-6611
Provider Business Mailing Address Fax Number:
215-338-9579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1822 AUGUSTINE CUT OFF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19803-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-735-4630
Provider Business Practice Location Address Fax Number:
302-427-3682
Provider Enumeration Date:
08/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAWALL
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-338-6611

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  2003107597 , registered in the state of DE ; 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