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General NPI Number Information
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NPI Number | 1366444739
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Entity Type | Organization
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Legal Business Name | CORNELL ORTHOTICS AND PROSTHETICS, INC
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 100 CUMMINGS CTR SUITE 207H
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City | BEVERLY
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State | MA
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Zip | 01915-6115
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Country | US
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Telephone | 978-922-2866
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Fax | 978-922-0277
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Provider Business Mailing Address
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Address Line | 100 CUMMINGS CTR SUITE 207H
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City | BEVERLY
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State | MA
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Zip | 01915-6115
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Country | US
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Telephone | 978-922-2866
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Fax | 978-922-0277
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEITH DONALD CORNELL
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Credential | C.P.
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Telephone | 978-922-2866
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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 | MA
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