Healthcare Provider Details

I. General information

NPI: 1609940782
Provider Name (Legal Business Name): INNOVATIVE PROSTHETICS & ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 S 17TH ST SUITE 100
LINCOLN NE
68502-3750
US

IV. Provider business mailing address

2130 S 17TH ST SUITE 100
LINCOLN NE
68502-3750
US

V. Phone/Fax

Practice location:
  • Phone: 402-461-4931
  • Fax:
Mailing address:
  • Phone: 402-461-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ASHVINI SENGAR
Title or Position: DIRECTOR
Credential: MD
Phone: 402-460-5899