=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073315461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSTHETIC & ORTHOTIC ASSOCIATES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 ROUTE 6 AND 209 STE 102
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18337-7615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-956-0001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 RIVERSIDE DR
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10941-4064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-956-0001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | THOMAS PASSERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-956-0001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------