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General NPI Number Information
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NPI Number | 1639302045
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Entity Type | Organization
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Legal Business Name | IMPACT TECHNOLOGIES GROUP LLC
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 5401 N HAVERHILL RD SUITE 125
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-7005
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Country | US
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Telephone | 561-317-7546
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Fax | 561-296-6643
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Provider Business Mailing Address
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Address Line | 5401 N HAVERHILL RD SUITE 125
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-7005
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Country | US
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Telephone | 561-317-7546
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Fax | 561-296-6643
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Authorized Official
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Title or Position | CEO
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Name | MS. ANGELINA CEJA
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Credential |
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Telephone | 561-317-7546
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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 | 2009-00747
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2009-00747
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License Number State | FL
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