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General NPI Number Information
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NPI Number | 1962413765
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Entity Type | Organization
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Legal Business Name | SPECIALIZED ORTHOPAEDIC SERVICES,INC.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 307 MAPLE AVE WEST BUILDING F
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City | VIENNA
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State | VA
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Zip | 22180-4307
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Country | US
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Telephone | 703-281-1200
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Fax | 703-281-1201
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Provider Business Mailing Address
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Address Line | 307 MAPLE AVE WEST BUILDING F
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City | VIENNA
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State | VA
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Zip | 22180-4307
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Country | US
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Telephone | 703-281-1200
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Fax | 703-281-1201
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN (JAY) R KURELICH JR.
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Credential |
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Telephone | 703-281-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 1114
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License Number State | VA
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Taxonomy #2
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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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