=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457681652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE ORTHOPEDIC SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2010
-----------------------------------------------------
Last Update Date | 10/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5713 MAIN ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-5332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-321-0407
-----------------------------------------------------
Fax | 718-321-3484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2094 FRONT ST
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-1709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-357-9113
-----------------------------------------------------
Fax | 516-478-4420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. NOREEN DIAZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-357-9113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------