MEDICARE: JK PROSTHETICS AND ORTHOTICS

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1619043932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JK PROSTHETICS AND ORTHOTICS

Provider Business Mailing Address
First Line	:	699 N MACQUESTEN PKWY
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-2121
Country	:	US
Telephone Number	:	914-699-2077
Fax Number	:	914-699-0676

Provider Business Practice Location Address
First Line	:	699 N MACQUESTEN PKWY
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-2121
Country	:	US
Telephone Number	:	914-699-2077
Fax Number	:	914-699-0676

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MICHAEL JAMES CAPUTO
Credential	:
Telephone Number	:	914-699-2077

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	12/29/2008

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