Provider Demographics
NPI:1366018509
Name:MOTION ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:MOTION ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:MOTION SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:845-543-8800
Mailing Address - Street 1:75 MONTEBELLO RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 MONTEBELLO RD STE 207
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-3746
Practice Address - Country:US
Practice Address - Phone:619-867-6094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1447834692OtherNPI
NJ1710398706OtherNPI