Healthcare Provider Details

I. General information

NPI: 1669435129
Provider Name (Legal Business Name): JEFFERSON ORTHOPEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 CLEARVIEW PKWY
METAIRIE LA
70001
US

IV. Provider business mailing address

1612 CLEARVIEW PKWY
METAIRIE LA
70001
US

V. Phone/Fax

Practice location:
  • Phone: 504-888-0213
  • Fax: 504-888-0293
Mailing address:
  • Phone: 504-888-0213
  • Fax: 504-888-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number435810
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number435810
License Number StateLA

VIII. Authorized Official

Name: BRITTANY GRUNBERG
Title or Position: OWNER
Credential: CP-CERTIFIED ORTHOTI
Phone: 504-888-0213