Provider Demographics
NPI:1184179152
Name:ESCHEN PROSTHETIC & ORTHOTIC LABORATORIES, INC.
Entity Type:Organization
Organization Name:ESCHEN PROSTHETIC & ORTHOTIC LABORATORIES, INC.
Other - Org Name:EASTSIDE ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:212-606-1262
Mailing Address - Street 1:510 E 73RD ST
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4010
Mailing Address - Country:US
Mailing Address - Phone:212-606-1262
Mailing Address - Fax:212-606-1842
Practice Address - Street 1:889 HARRISON AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2090
Practice Address - Country:US
Practice Address - Phone:631-727-8735
Practice Address - Fax:631-727-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier