Healthcare Provider Details

I. General information

NPI: 1063453421
Provider Name (Legal Business Name): NEW ENGLAND ORTHOTIC & PROSTHETIC SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 GROVE STREET
WORCESTER MA
01605-1270
US

IV. Provider business mailing address

16 COMMERCIAL ST
BRANFORD CT
06405-2801
US

V. Phone/Fax

Practice location:
  • Phone: 508-890-8808
  • Fax: 508-890-8818
Mailing address:
  • Phone: 203-483-8488
  • Fax: 203-483-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110029460/B
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MR. DAVID MAHLER
Title or Position: CEO
Credential: CPO
Phone: 203-483-8488