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General NPI Number Information
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NPI Number | 1750273207
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Entity Type | Organization
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Legal Business Name | ORTHOTICS & PROSTHETICS STAT INC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1250 WATERS PL
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City | BRONX
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State | NY
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Zip | 10461-2720
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Country | US
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Telephone | 516-633-3506
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Fax |
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Provider Business Mailing Address
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Address Line | 99 BEACH RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-6614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | NICHOLAS DIAZ
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Credential |
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Telephone | 516-633-3506
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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 |
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License Number State |
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