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General NPI Number Information
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NPI Number | 1124399084
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Entity Type | Organization
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Legal Business Name | NORTHEAST ORTHOTICS & PROSTHETICS, INC.
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 765 ALLENS AVE SUITE 250
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City | PROVIDENCE
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State | RI
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Zip | 02905-5443
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Country | US
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Telephone | 401-437-8016
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Fax | 401-437-8923
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Provider Business Mailing Address
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Address Line | 765 ALLENS AVE SUITE 250
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City | PROVIDENCE
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State | RI
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Zip | 02905-5443
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Country | US
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Telephone | 401-437-8016
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Fax | 401-437-8923
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Authorized Official
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Title or Position | OWNER
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Name | MARK STEVEN MARICH
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Credential | CPO
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Telephone | 401-437-8016
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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 | CO00011
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License Number State | RI
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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 | CPO00018
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License Number State | RI
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