Provider Demographics
NPI:1073911335
Name:SUPERTECH ORTHOTICS & PROSTHETICS LLC
Entity Type:Organization
Organization Name:SUPERTECH ORTHOTICS & PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAYA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:832-775-0633
Mailing Address - Street 1:9888 BISSONNET ST STE 530
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8250
Mailing Address - Country:US
Mailing Address - Phone:832-775-0633
Mailing Address - Fax:281-207-5339
Practice Address - Street 1:9888 BISSONNET ST STE 530
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8250
Practice Address - Country:US
Practice Address - Phone:832-775-0633
Practice Address - Fax:281-207-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier