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General NPI Number Information
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NPI Number | 1750844239
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Entity Type | Organization
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Legal Business Name | ADVANCE PROSTHETIC AND ORTHOTIC INC
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 111 DEAN DR
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City | TENAFLY
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State | NJ
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Zip | 07670-2764
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Country | US
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Telephone | 201-429-6960
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Fax | 201-429-6961
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Provider Business Mailing Address
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Address Line | 51 CURTMANTLE RD
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City | MICKLETON
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State | NJ
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Zip | 08056-1263
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Country | US
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Telephone | 201-317-3442
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Fax | 201-353-2343
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MATHEWS MANCHA
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Credential |
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Telephone | 201-317-3443
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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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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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