Healthcare Provider Details

I. General information

NPI: 1366018509
Provider Name (Legal Business Name): MOTION ORTHOTICS AND PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MONTEBELLO RD STE 207
MONTEBELLO NY
10901-3746
US

IV. Provider business mailing address

75 MONTEBELLO RD STE 207
MONTEBELLO NY
10901-3746
US

V. Phone/Fax

Practice location:
  • Phone: 619-867-6094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GLENN ALLEN BEALL
Title or Position: CHIEF MEDICAL OFFICER
Credential: CPO
Phone: 845-543-8800