MEDICARE: MR. BETHANAPALLI BOSE CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	1127940	NY
2	224P00000X	Prosthetist	1127940	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174696736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BETHANAPALLI BOSE CPO

Provider Business Mailing Address
First Line	:	1-25 26TH ST
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-3802
Country	:	US
Telephone Number	:	718-680-0225
Fax Number	:	201-796-5414

Provider Business Practice Location Address
First Line	:	6911 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1101
Country	:	US
Telephone Number	:	718-680-0225
Fax Number	:	201-796-5414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/01/2008

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