Healthcare Provider Details

I. General information

NPI: 1942431853
Provider Name (Legal Business Name): STRIDE ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ORISKANY BLVD
YORKVILLE NY
13495-1324
US

IV. Provider business mailing address

44 ORISKANY BLVD
YORKVILLE NY
13495-1324
US

V. Phone/Fax

Practice location:
  • Phone: 315-736-0161
  • Fax: 315-736-0570
Mailing address:
  • Phone: 315-736-0161
  • Fax: 315-736-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSHUA JON MULLEN
Title or Position: PRESIDENT
Credential: C.P.O.
Phone: 315-430-5136