Provider Demographics
NPI:1083631931
Name:ORTHOTIC PROSTHETIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ORTHOTIC PROSTHETIC ASSOCIATES, INC.
Other - Org Name:RJM ORTHOTIC & PROSTHETIC ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANFREDI
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:732-905-9020
Mailing Address - Street 1:2105 WEST COUNTY LINE ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527
Mailing Address - Country:US
Mailing Address - Phone:732-905-9020
Mailing Address - Fax:732-905-9088
Practice Address - Street 1:2105 WEST COUNTY LINE ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527
Practice Address - Country:US
Practice Address - Phone:732-905-9020
Practice Address - Fax:732-905-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
NJ45PO00004400335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNL2966OtherHEALTHNET
NJ1111538OtherHORIZON NJ HEALTH
NJ9615438OtherCIGNA
NJ39784OtherUHP
NJ0005089743OtherAETNA
NJ57609OtherNORTHWOOD
NJ9036105Medicaid
NJ=========AOtherHORIZON BC BS OF NJ
NJ9615438OtherCIGNA
NJ=========OtherMSC
NJ=========0OtherHORIZON BC BS OF NJ
NJNL2966OtherHEALTHNET
NJ9036105Medicaid
NJ39784OtherUHP