MEDICARE: ORTHO-BIONICS LABORATORY, 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	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	:	1669442430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO-BIONICS LABORATORY, INC.

Provider Business Mailing Address
First Line	:	11442 ROCKAWAY BLVD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-1928
Country	:	US
Telephone Number	:	718-845-5572
Fax Number	:

Provider Business Practice Location Address
First Line	:	11442 ROCKAWAY BLVD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-1928
Country	:	US
Telephone Number	:	718-845-5572
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAYMOND MARX
Credential	:	CPO
Telephone Number	:	718-845-5572

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/22/2020

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Directions to “ORTHO-BIONICS LABORATORY, INC. ” Practice Location

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