MEDICARE: EASTSIDE ORTHOTICS & PROSTHETICS INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568466068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE ORTHOTICS & PROSTHETICS INC

Provider Business Mailing Address
First Line	:	34 COMMERCE DR
Second Line	:	STE 200
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-3118
Country	:	US
Telephone Number	:	631-727-8735
Fax Number	:	631-727-6834

Provider Business Practice Location Address
First Line	:	388 WESTCHESTER AVE
Second Line	:	STE 1J
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-3623
Country	:	US
Telephone Number	:	914-935-1185
Fax Number	:	914-935-1187

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATTHEW D FLYNN
Credential	:	CP
Telephone Number	:	631-727-8735

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/05/2008

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Directions to “EASTSIDE ORTHOTICS & PROSTHETICS INC ” Practice Location

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