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General NPI Number Information
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NPI Number | 1871853101
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Entity Type | Organization
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Legal Business Name | MODERN LIMB & BRACE CO INC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 916 SOMERSET ST
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City | WATCHUNG
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State | NJ
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Zip | 07069-6305
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Country | US
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Telephone | 908-757-2702
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Fax | 908-757-0744
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Provider Business Mailing Address
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Address Line | 916 SOMERSET ST
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City | WATCHUNG
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State | NJ
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Zip | 07069-6305
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Country | US
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Telephone | 908-757-2702
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Fax | 908-757-0744
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Authorized Official
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Title or Position | OWNER/CP,LPO
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Name | MR. HORST H OERTEL
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Credential | CP
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Telephone | 908-757-2702
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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 | 45PO00004800
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License Number State | NJ
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