Provider Demographics
NPI:1356490536
Name:G F H ORTHOTIC AND PROSTHETIC LABORATORIES INC
Entity Type:Organization
Organization Name:G F H ORTHOTIC AND PROSTHETIC LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST ORTHOTIST OWN
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:631-467-3725
Mailing Address - Street 1:161 KEYLAND CT
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2621
Mailing Address - Country:US
Mailing Address - Phone:631-467-3725
Mailing Address - Fax:631-467-3512
Practice Address - Street 1:161 KEYLAND CT
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2621
Practice Address - Country:US
Practice Address - Phone:631-467-3725
Practice Address - Fax:631-467-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00435901Medicaid
NY0171740001Medicare ID - Type Unspecified