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General NPI Number Information
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NPI Number | 1104808716
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Entity Type | Organization
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Legal Business Name | PRO-THOTICS TECHNOLOGY INC
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 285 SILLS RD BUILDING 3 SUITE D
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4869
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Country | US
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Telephone | 631-569-5562
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Fax | 631-569-5565
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Provider Business Mailing Address
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Address Line | 285 SILLS RD BUILDING 3 SUITE D
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4869
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Country | US
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Telephone | 631-569-5562
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Fax | 631-569-5565
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN P AFFENITA
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Credential |
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Telephone | 631-569-5562
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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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