Provider Demographics
NPI:1164005385
Name:AGAPE ORTHOTICS OF NC
Entity Type:Organization
Organization Name:AGAPE ORTHOTICS OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CIPRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUFULETE
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:910-574-9804
Mailing Address - Street 1:PO BOX 58296
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-8296
Mailing Address - Country:US
Mailing Address - Phone:910-574-9804
Mailing Address - Fax:
Practice Address - Street 1:25 AMARILLO LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-3018
Practice Address - Country:US
Practice Address - Phone:910-574-9804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies