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General NPI Number Information
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NPI Number | 1083631931
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Entity Type | Organization
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Legal Business Name | ORTHOTIC PROSTHETIC ASSOCIATES, INC.
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 2105 WEST COUNTY LINE ROAD SUITE 9
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City | JACKSON
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State | NJ
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Zip | 08527
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Country | US
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Telephone | 732-905-9020
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Fax | 732-905-9088
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Provider Business Mailing Address
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Address Line | 2105 WEST COUNTY LINE ROAD SUITE 9
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City | JACKSON
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State | NJ
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Zip | 08527
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Country | US
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Telephone | 732-905-9020
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Fax | 732-905-9088
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RICHARD J MANFREDI
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Credential | CP
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Telephone | 732-905-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 45PO00004400
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License Number State | NJ
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