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General NPI Number Information
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NPI Number | 1376690982
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC APPLIANCE & BRACE CENTER INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 280 BROADWAY
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City | PROVIDENCE
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State | RI
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Zip | 02903-3007
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Country | US
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Telephone | 401-331-5548
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Fax | 401-621-8691
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Provider Business Mailing Address
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Address Line | 280 BROADWAY
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City | PROVIDENCE
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State | RI
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Zip | 02903-3007
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Country | US
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Telephone | 401-331-5548
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Fax | 401-621-8691
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. WILLIAM PETER LONARDO
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Credential | C.O.
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Telephone | 401-331-5548
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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 | CP00008
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License Number State | RI
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