Healthcare Provider Details

I. General information

NPI: 1669713467
Provider Name (Legal Business Name): PRESQUE ISLE ORTHOTICS AND PROSTHETICS OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 HORTON DR
SILVER SPRING MD
20902-3009
US

IV. Provider business mailing address

2101 RICHMOND RD STE 1000
BEACHWOOD OH
44122-1390
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-8658
  • Fax: 866-536-2954
Mailing address:
  • Phone: 216-371-0660
  • Fax: 866-536-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SOLOMON HEIFETZ
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 301-681-8658