Provider Demographics
NPI:1366685372
Name:PREMIER ORTHOPEDIC SUPPLY, INC.
Entity Type:Organization
Organization Name:PREMIER ORTHOPEDIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:631-831-5343
Mailing Address - Street 1:169 COMMACK RD
Mailing Address - Street 2:SUITE H PMB 387
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3442
Mailing Address - Country:US
Mailing Address - Phone:631-831-5343
Mailing Address - Fax:631-940-5966
Practice Address - Street 1:169 COMMACK RD
Practice Address - Street 2:SUITE H PMB 387
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3442
Practice Address - Country:US
Practice Address - Phone:631-831-5343
Practice Address - Fax:631-940-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier