1679043525 NPI number — ADAPTIVE PROSTHETICS & ORTHOTICS LLC

Table of content: (NPI 1679043525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679043525 NPI number — ADAPTIVE PROSTHETICS & ORTHOTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAPTIVE PROSTHETICS & ORTHOTICS 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:
1679043525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 NATIONAL DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06033-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-633-7298
Provider Business Mailing Address Fax Number:
860-659-1282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 RETREAT AVE STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-266-1845
Provider Business Practice Location Address Fax Number:
860-757-5803
Provider Enumeration Date:
12/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HEWETT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-633-7298

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: 004178770 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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