MEDICARE: MODERN LIMB & BRACE CO 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	45PO00004800	NJ

General Provider Information

NPI Number	:	1871853101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN LIMB & BRACE CO INC

Provider Business Mailing Address
First Line	:	916 SOMERSET ST
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6305
Country	:	US
Telephone Number	:	908-757-2702
Fax Number	:	908-757-0744

Provider Business Practice Location Address
First Line	:	916 SOMERSET ST
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6305
Country	:	US
Telephone Number	:	908-757-2702
Fax Number	:	908-757-0744

Authorized Official
Title or Position	:	OWNER/CP,LPO
Name	:	MR. HORST H OERTEL
Credential	:	CP
Telephone Number	:	908-757-2702

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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