MEDICARE: EMPIRE PROSTHETICS AND ORTHOTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093839334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE PROSTHETICS AND ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	119 W 23RD ST
Second Line	:	SUITE 1002
City	:	NEW YORK
State	:	NY
Zip	:	10011-2427
Country	:	US
Telephone Number	:	212-243-2972
Fax Number	:	212-243-5213

Provider Business Practice Location Address
First Line	:	119 W 23RD ST
Second Line	:	SUITE 1002
City	:	NEW YORK
State	:	NY
Zip	:	10011-2427
Country	:	US
Telephone Number	:	212-243-2972
Fax Number	:	212-243-5213

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. GARRETT PASCAVAGE
Credential	:	CPO
Telephone Number	:	212-243-2972

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

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