Provider Demographics
NPI:1023029055
Name:PROSTHETIC REHABILITATION CENTER
Entity Type:Organization
Organization Name:PROSTHETIC REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARUBIA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:845-565-8255
Mailing Address - Street 1:2 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2223
Mailing Address - Country:US
Mailing Address - Phone:845-565-8255
Mailing Address - Fax:845-565-4409
Practice Address - Street 1:2 WINDING LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2223
Practice Address - Country:US
Practice Address - Phone:845-565-8255
Practice Address - Fax:845-565-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01148407Medicaid
NYG54151OtherBC/BS
NY01148407Medicaid