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General NPI Number Information
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NPI Number | 1376544718
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Entity Type | Organization
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Legal Business Name | PROTHOTIC LABORATORY, INC.
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 2023 NEW HWY
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City | FARMINGDALE
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State | NY
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Zip | 11735-1103
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Country | US
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Telephone | 631-753-4444
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Fax | 631-753-4451
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Provider Business Mailing Address
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Address Line | 2023 NEW HWY
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City | FARMINGDALE
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State | NY
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Zip | 11735-1103
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Country | US
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Telephone | 631-753-4444
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Fax | 631-753-4451
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Authorized Official
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Title or Position | CEO
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Name | CHARLES J QUIGG
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Credential | CPO
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Telephone | 631-753-4444
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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 |
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