Provider Demographics
NPI:1285027557
Name:PROTHOTICS TECHNOLOGY INC
Entity Type:Organization
Organization Name:PROTHOTICS TECHNOLOGY INC
Other - Org Name:PROTHOTICS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:AFFENITA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:631-438-1075
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BLDG 3 STE D
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:877-776-8400
Mailing Address - Fax:877-366-5492
Practice Address - Street 1:280 E 161ST ST
Practice Address - Street 2:SIDE ENTRANCE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3521
Practice Address - Country:US
Practice Address - Phone:877-776-8400
Practice Address - Fax:877-366-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0445310001Medicare NSC