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General NPI Number Information
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NPI Number | 1487191862
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Entity Type | Organization
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Legal Business Name | NORTHEAST ORTHOTICS INC.
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3223 N BROAD ST STE 150
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 215-707-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 2326 S COLORADO ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-4321
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Country | US
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Telephone | 215-868-7120
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Fax | 267-818-1068
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL A SAVLOFF
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Credential | C.O., C.PED., CFO
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Telephone | 215-868-7120
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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 | PD000109
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | OF000151
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 45PD00001000
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | OH000284
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License Number State | PA
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