Provider Demographics
NPI:1235291378
Name:BT ORTHOTIC LABS, INC.
Entity Type:Organization
Organization Name:BT ORTHOTIC LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT / CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-470-3778
Mailing Address - Street 1:96 E MAIN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2816
Mailing Address - Country:US
Mailing Address - Phone:631-470-3778
Mailing Address - Fax:631-423-1550
Practice Address - Street 1:96 E MAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2816
Practice Address - Country:US
Practice Address - Phone:631-470-3778
Practice Address - Fax:631-423-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6385910001Medicare NSC