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General NPI Number Information
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NPI Number | 1265973002
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Entity Type | Organization
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Legal Business Name | BRYTHONIC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 7 MILL POND RD
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City | MARLBORO
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State | NY
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Zip | 12542-5153
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Country | US
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Telephone | 845-264-9569
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Fax | 845-236-3704
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Provider Business Mailing Address
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Address Line | 7 MILL POND ROAD
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City | MARLBORO
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State | NY
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Zip | 12542
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Country | US
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Telephone | 845-264-9569
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Fax | 845-236-3704
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD ANTHONY ALLEN
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Credential | BOCPO
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Telephone | 845-264-9569
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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 | C36447
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License Number State | NY
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