Healthcare Provider Details

I. General information

NPI: 1871586883
Provider Name (Legal Business Name): GREEN PROSTHETICS & ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 PENINSULA DR
ERIE PA
16506-2954
US

IV. Provider business mailing address

2241 PENINSULA DR
ERIE PA
16506-2954
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-2311
  • Fax: 814-833-5202
Mailing address:
  • Phone: 814-833-2311
  • Fax: 814-833-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6000005987
License Number StatePA

VIII. Authorized Official

Name: MR. RAKESH JAIN
Title or Position: CEO
Credential:
Phone: 201-774-1085