Provider Demographics
NPI:1306377809
Name:PROSTHETIC AND ORTHOTIC DESIGNS, LLC
Entity Type:Organization
Organization Name:PROSTHETIC AND ORTHOTIC DESIGNS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST ORTHOTIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO-LPO
Authorized Official - Phone:845-480-4391
Mailing Address - Street 1:110 CRYSTAL RUN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4004
Mailing Address - Country:US
Mailing Address - Phone:845-703-8134
Mailing Address - Fax:845-703-8135
Practice Address - Street 1:110 CRYSTAL RUN RD STE 109
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4004
Practice Address - Country:US
Practice Address - Phone:845-703-8134
Practice Address - Fax:845-703-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-25
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00016200335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier