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General NPI Number Information
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NPI Number | 1639245640
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Entity Type | Organization
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Legal Business Name | PEDORTHIC CONCEPTS INC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 145 ATLANTIC CITY BLVD
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City | BEACHWOOD
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State | NJ
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Zip | 08722
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Country | US
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Telephone | 732-341-6262
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Fax | 732-341-5464
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Provider Business Mailing Address
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Address Line | 145 ATLANTIC CITY BLVD
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City | BEACHWOOD
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State | NJ
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Zip | 08722
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Country | US
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Telephone | 732-341-6262
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Fax | 732-341-5464
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Authorized Official
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Title or Position | OFFICE MGR
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Name | MRS. PATRICIA DEQUEIROZ
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Credential |
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Telephone | 732-341-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number |
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License Number State |
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