Healthcare Provider Details

I. General information

NPI: 1982881983
Provider Name (Legal Business Name): MANCHESTER ORTHOPEDIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 07/21/2022
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 ROUTE 59 STE 214
AIRMONT NY
10952-3459
US

IV. Provider business mailing address

365 ROUTE 59 STE 214
AIRMONT NY
10952-3459
US

V. Phone/Fax

Practice location:
  • Phone: 718-925-2922
  • Fax: 718-925-2232
Mailing address:
  • Phone: 718-925-2922
  • Fax: 718-925-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ABRAHAM TEITELBAUM
Title or Position: PRES.
Credential: C.O.
Phone: 718-925-2922