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General NPI Number Information
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NPI Number | 1285129205
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Entity Type | Organization
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Legal Business Name | TRISETO ORTHOTIC SOLUTIONS, INC.
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 2 LAWSON AVE UNIT 2
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1700
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Country | US
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Telephone | 516-837-3177
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Fax | 212-879-5175
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Provider Business Mailing Address
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Address Line | 2 LAWSON AVE UNIT 2
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1700
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Country | US
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Telephone | 516-837-3177
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Fax | 212-879-5175
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. ROBERT NEAL LAKE
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Credential | LPO
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Telephone | 516-837-3177
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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 | POR335
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License Number State | FL
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