Healthcare Provider Details

I. General information

NPI: 1437661493
Provider Name (Legal Business Name): ORTHOBODY MEDICAL EQUIPMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 W 185TH ST
NEW YORK NY
10033-3102
US

IV. Provider business mailing address

629 W 185TH ST
NEW YORK NY
10033-3102
US

V. Phone/Fax

Practice location:
  • Phone: 917-409-2876
  • Fax:
Mailing address:
  • Phone: 917-409-2876
  • 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: LUCY C VILLA-TINEO
Title or Position: OFFICER
Credential:
Phone: 917-409-2876