MEDICARE: STUART PEDORTHICS, INC.

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1467454777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUART PEDORTHICS, INC.

Provider Business Mailing Address
First Line	:	17816 CHATSWORTH ST.
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5611
Country	:	US
Telephone Number	:	818-831-8507
Fax Number	:	818-831-8527

Provider Business Practice Location Address
First Line	:	17816 CHATSWORTH ST.
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5611
Country	:	US
Telephone Number	:	818-831-8507
Fax Number	:	818-831-8527

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STUART NEAL LUTWAK
Credential	:	C.PED.
Telephone Number	:	818-831-8507

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/22/2020

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Directions to “STUART PEDORTHICS, INC. ” Practice Location

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