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General NPI Number Information
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NPI Number | 1720441272
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Entity Type | Organization
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Legal Business Name | SHORE PROSTHETICS AND ORTHOTICS LLC
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 4605 TUTU PARK MALL STE 102A
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City | ST THOMAS
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State | VI
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Zip | 00802-1736
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Country | US
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Telephone | 340-714-1009
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Fax | 866-294-9581
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Provider Business Mailing Address
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Address Line | 844 RITCHIE HWY STE 202
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City | SEVERNA PARK
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State | MD
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Zip | 21146-4137
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Country | US
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Telephone | 410-897-1141
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Fax | 866-294-9581
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Authorized Official
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Title or Position | CEO
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Name | SOLOMON HEIFETZ
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Credential |
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Telephone | 410-897-1141
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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 | 1-21556-1L
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License Number State | VI
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