=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346420742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSTHETIC HOME SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 11/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10654 MAIN ST
-----------------------------------------------------
City | CLARENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14031-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-759-9111
-----------------------------------------------------
Fax | 716-759-9112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10654 MAIN ST
-----------------------------------------------------
City | CLARENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14031-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-759-9111
-----------------------------------------------------
Fax | 716-759-9112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MARK ZUCHLEWSKI
-----------------------------------------------------
Credential | CP
-----------------------------------------------------
Telephone | 716-759-9111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | CP002723
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------