MEDICARE: EAST COAST ORTHOTIC & PROSTHETIC CORP

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

General Provider Information

NPI Number	:	1730318072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST ORTHOTIC & PROSTHETIC CORP

Provider Business Mailing Address
First Line	:	75 BURT DR
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-5701
Country	:	US
Telephone Number	:	631-254-5577
Fax Number	:	631-254-5550

Provider Business Practice Location Address
First Line	:	505 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1309
Country	:	US
Telephone Number	:	716-856-5192
Fax Number	:	716-856-5246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LAWRENCE J BENENATI
Credential	:
Telephone Number	:	631-392-2228

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	11/02/2018

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Directions to “EAST COAST ORTHOTIC & PROSTHETIC CORP ” Practice Location

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