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General NPI Number Information
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NPI Number | 1598491490
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Entity Type | Organization
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Legal Business Name | ORTHOTIC AND PROSTHETIC SERVICES INC.
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 786 CASTLETON AVE.
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City | SI
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State | NY
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Zip | 10310
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Country | US
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Telephone | 646-262-1845
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Fax |
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Provider Business Mailing Address
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Address Line | 141 SILOAM RD
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City | FREEHOLD
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State | NJ
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Zip | 07728-8608
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Country | US
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Telephone | 646-262-1845
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. GLENN EASTON
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Credential | CO, LPO, BOCP
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Telephone | 646-262-1845
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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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