MEDICARE: EAST COAST ORTHOTIC & PROSTHETIC CORP..

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

General Provider Information

NPI Number	:	1417304080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST ORTHOTIC & PROSTHETIC CORP..

Provider Business Mailing Address
First Line	:	75 BURT DR
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-5701
Country	:	US
Telephone Number	:	631-254-5577
Fax Number	:	631-254-5550

Provider Business Practice Location Address
First Line	:	1100 BEDFORD ST
Second Line	:	SUITE 280
City	:	STAMFORD
State	:	CT
Zip	:	06905-5305
Country	:	US
Telephone Number	:	203-504-8903
Fax Number	:	203-504-8905

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LAWRENCE J. BENENATI
Credential	:
Telephone Number	:	631-392-2228

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	11/02/2018

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Directions to “EAST COAST ORTHOTIC & PROSTHETIC CORP.. ” Practice Location

Language	Start Address	Practice Location

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