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General NPI Number Information
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NPI Number | 1902105505
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Entity Type | Organization
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Legal Business Name | BRAY ORTHOTICS AND PROSTHETICS LLC
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 217 OLD HOOK RD
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City | WESTWOOD
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State | NJ
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Zip | 07675-3130
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Country | US
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Telephone | 201-666-6647
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Fax | 201-666-5551
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Provider Business Mailing Address
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Address Line | 217 OLD HOOK RD
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City | WESTWOOD
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State | NJ
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Zip | 07675-3130
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Country | US
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Telephone | 201-666-6647
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Fax | 201-666-5551
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. RICHARD J BRAY
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Credential | CPO,CPED
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Telephone | 201-666-6647
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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 | 45P000014900
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License Number State | NJ
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