Healthcare Provider Details
I. General information
NPI: 1780302703
Provider Name (Legal Business Name): ADVANCED RECOVERY ORTHOTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
699 PARK LN
CEDARHURST NY
11516-1026
US
IV. Provider business mailing address
699 PARK LN
CEDARHURST NY
11516-1026
US
V. Phone/Fax
- Phone: 516-744-0010
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225000000X |
| Taxonomy | Orthotic Fitter |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
PINCHAS
MIRAKOV
Title or Position: OWNER
Credential:
Phone: 516-744-0010