Provider Demographics
NPI:1043085210
Name:SHORE PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:SHORE PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIFETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-897-1141
Mailing Address - Street 1:14055 CEDAR RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3333
Mailing Address - Country:US
Mailing Address - Phone:410-897-1141
Mailing Address - Fax:
Practice Address - Street 1:4050 ESTATE LA GRANDE PRINCESSE STE 7
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4328
Practice Address - Country:US
Practice Address - Phone:340-714-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier