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General NPI Number Information
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NPI Number | 1093890832
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Entity Type | Organization
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Legal Business Name | NEW YORK ORTHOTIC AND PROSTHETIC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 67 IRVING PL, SOUTH
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City | NEW YORK
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State | NY
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Zip | 10003-2202
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Country | US
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Telephone | 212-673-6267
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Fax |
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Provider Business Mailing Address
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Address Line | 505 NORTHERN BLVD
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City | GREAT NECK
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State | NY
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Zip | 11021-5101
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Country | US
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Telephone | 516-466-6751
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. IRA MILLER
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Credential |
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Telephone | 212-673-6267
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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 | 859
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License Number State | NY
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