Provider Demographics
NPI:1043285240
Name:BENCHMARK ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:BENCHMARK ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:BENCHMARK ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:200 COLLEGE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-9608
Mailing Address - Country:US
Mailing Address - Phone:724-438-6444
Mailing Address - Fax:724-438-2982
Practice Address - Street 1:200 COLLEGE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456-9608
Practice Address - Country:US
Practice Address - Phone:724-438-6444
Practice Address - Fax:724-438-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006107335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01952216Medicaid
PA4318080026Medicare ID - Type UnspecifiedMEDICARE PROVIDER#