Provider Demographics
NPI:1114989365
Name:THE CENTER FOR ORTHOTIC & PROSTHETICS SERVICES
Entity Type:Organization
Organization Name:THE CENTER FOR ORTHOTIC & PROSTHETICS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CALLAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CO
Authorized Official - Phone:908-686-0838
Mailing Address - Street 1:1585 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6300
Mailing Address - Country:US
Mailing Address - Phone:908-686-0838
Mailing Address - Fax:908-686-3575
Practice Address - Street 1:1585 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6300
Practice Address - Country:US
Practice Address - Phone:908-686-0838
Practice Address - Fax:908-686-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00012100222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0782840001Medicare ID - Type UnspecifiedPROVIDER #