Provider Demographics
NPI:1285826222
Name:STELLAR PROSTHETICS, INC
Entity Type:Organization
Organization Name:STELLAR PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:PROSTHETIC PRACTICE
Authorized Official - Phone:215-364-5727
Mailing Address - Street 1:55 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1501
Mailing Address - Country:US
Mailing Address - Phone:215-364-5727
Mailing Address - Fax:
Practice Address - Street 1:55 BUCK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1501
Practice Address - Country:US
Practice Address - Phone:215-364-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACP2557332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5570620001Medicare NSC