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General NPI Number Information
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NPI Number | 1669435129
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Entity Type | Organization
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Legal Business Name | JEFFERSON ORTHOPEDICS INC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 1612 CLEARVIEW PKWY
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City | METAIRIE
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State | LA
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Zip | 70001
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Country | US
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Telephone | 504-888-0213
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Fax | 504-888-0293
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Provider Business Mailing Address
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Address Line | 1612 CLEARVIEW PKWY
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City | METAIRIE
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State | LA
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Zip | 70001
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Country | US
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Telephone | 504-888-0213
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Fax | 504-888-0293
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Authorized Official
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Title or Position | OWNER
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Name | BRITTANY GRUNBERG
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Credential | CP-CERTIFIED ORTHOTI
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Telephone | 504-888-0213
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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 | 435810
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 435810
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License Number State | LA
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