MEDICARE: DYNAMIC 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

General Provider Information

NPI Number	:	1689744690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC PROSTHETICS INC

Provider Business Mailing Address
First Line	:	186 RED HICKORY DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4033
Country	:	US
Telephone Number	:	585-227-0790
Fax Number	:	585-227-8562

Provider Business Practice Location Address
First Line	:	1401 STONE RD STE 201
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-1537
Country	:	US
Telephone Number	:	585-227-0790
Fax Number	:	585-227-8562

Authorized Official
Title or Position	:	OWNER
Name	:	MR. IGNAZIO CANCELLIERI
Credential	:	CPED, BOC OC, ABC OC
Telephone Number	:	585-303-1886

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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Directions to “DYNAMIC PROSTHETICS INC ” Practice Location

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