Provider Demographics
NPI:1033777248
Name:BEACH ORTHOTICS
Entity Type:Organization
Organization Name:BEACH ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIBIGA
Authorized Official - Suffix:III
Authorized Official - Credentials:CFO
Authorized Official - Phone:757-470-5547
Mailing Address - Street 1:6325 N CENTER DR STE 229
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-0013
Mailing Address - Country:US
Mailing Address - Phone:757-470-5547
Mailing Address - Fax:866-452-0279
Practice Address - Street 1:6325 N CENTER DR STE 229
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-0013
Practice Address - Country:US
Practice Address - Phone:757-470-5547
Practice Address - Fax:866-452-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies