Healthcare Provider Details

I. General information

NPI: 1104049428
Provider Name (Legal Business Name): BAY ORTHOPEDIC AND REHABILITATION SUPPLY COMPANY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY RD
PLAINVIEW NY
11803-4938
US

IV. Provider business mailing address

PO BOX 890
PLAINVIEW NY
11803-4938
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-7200
  • Fax: 516-333-7277
Mailing address:
  • Phone: 516-333-7200
  • Fax: 516-333-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01014144
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MR. MICHAEL MANGINO
Title or Position: OWNER/PRESIDENT
Credential: C.P.O., C.PED.
Phone: 631-271-0825