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General NPI Number Information
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NPI Number | 1609089523
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Entity Type | Organization
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Legal Business Name | JEFFERSON PROSTHETIC & ORTHOTIC COMPANY, INC.
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 120 PROSPECT ST
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2103
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Country | US
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Telephone | 973-762-0780
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Fax | 973-762-1480
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Provider Business Mailing Address
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Address Line | 120 PROSPECT ST
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2103
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Country | US
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Telephone | 973-762-0780
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Fax | 973-762-1480
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SIMON C. W. CHANG
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Credential | C.P.O.
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Telephone | 973-762-0780
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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 | 45PO00002400
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License Number State | NJ
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