Healthcare Provider Details

I. General information

NPI: 1366880957
Provider Name (Legal Business Name): ORTHOPEDIC TREATMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LEXINGTON AVE NUM 182
NEW YORK NY
10128-1145
US

IV. Provider business mailing address

1324 LEXINGTON AVE NUM 182
NEW YORK NY
10128-1145
US

V. Phone/Fax

Practice location:
  • Phone: 646-593-8669
  • Fax: 646-569-9243
Mailing address:
  • Phone: 646-593-8669
  • Fax: 646-569-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: PUCCINI INOKON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 646-244-8595