Provider Demographics
NPI:1063453421
Name:NEW ENGLAND ORTHOTIC & PROSTHETIC SYSTEMS, LLC
Entity Type:Organization
Organization Name:NEW ENGLAND ORTHOTIC & PROSTHETIC SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:203-483-8488
Mailing Address - Street 1:16 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2801
Mailing Address - Country:US
Mailing Address - Phone:203-483-8488
Mailing Address - Fax:203-483-6085
Practice Address - Street 1:405 GROVE STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1270
Practice Address - Country:US
Practice Address - Phone:508-890-8808
Practice Address - Fax:508-890-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110029460/BMedicaid
MA110029460/BMedicaid