MEDICARE: MODERN LIMB & BRACE CO.

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	2758	OTHER	NJ	LIBERTY HEALTH PLANS
2	555663	OTHER	NJ	PMSI
3	0003963000	OTHER	NJ	AMERIHEALTH
4	SO000006600	OTHER	NJ	AMERICHOICE
5	2K1884	OTHER	NJ	HEALTHNET
6	040045	OTHER	NJ	AETNA
7	10540304	OTHER	NJ	GUARDIAN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1066390	OTHER	NJ	HORIZON NJ HEALTH
10	1487608311	OTHER	NJ	HORIZON BCBS
11	260248900	OTHER	NJ	ACS - US DEPT LABOR
12	260248900	OTHER	NJ	STATE OF NJ - WORKERS COMP
13	A522677	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1487608311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN LIMB & BRACE CO.

Provider Business Mailing Address
First Line	:	916 SOMERSET ST
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6305
Country	:	US
Telephone Number	:	908-757-2702
Fax Number	:	908-757-0744

Provider Business Practice Location Address
First Line	:	916 SOMERSET ST
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6305
Country	:	US
Telephone Number	:	908-757-2702
Fax Number	:	908-757-0744

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HORST OERTEL
Credential	:	C.P.
Telephone Number	:	908-757-2702

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	11/21/2012

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Directions to “MODERN LIMB & BRACE CO. ” Practice Location

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