Healthcare Provider Details

I. General information

NPI: 1497872881
Provider Name (Legal Business Name): FALK PROSTHETICS & ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 S ALTERNATE A1A SUITE 130
JUPITER FL
33477-4072
US

IV. Provider business mailing address

5180 W ATLANTIC AVE SUITE 116
DELRAY BEACH FL
33484-8103
US

V. Phone/Fax

Practice location:
  • Phone: 561-741-0488
  • Fax: 561-741-0498
Mailing address:
  • Phone: 561-495-5040
  • Fax: 561-495-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberPOR11
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPOR11
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID L FALK
Title or Position: OWNER
Credential: CPO
Phone: 561-741-0488