Healthcare Provider Details

I. General information

NPI: 1841295037
Provider Name (Legal Business Name): CLINICAL PROSTHETICS & ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MANSION ST SUITE 200
POUGHKEEPSIE NY
12601-2309
US

IV. Provider business mailing address

7 MANSION ST SUITE 200
POUGHKEEPSIE NY
12601-2309
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-1060
  • Fax: 845-486-1057
Mailing address:
  • Phone: 845-486-1060
  • Fax: 845-486-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID MISENER
Title or Position: AUTHORIZED OFFICIAL
Credential: CPO
Phone: 518-432-0683