Provider Demographics
NPI:1376690982
Name:ORTHOPEDIC APPLIANCE & BRACE CENTER INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC APPLIANCE & BRACE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LONARDO
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:401-331-5548
Mailing Address - Street 1:280 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3007
Mailing Address - Country:US
Mailing Address - Phone:401-331-5548
Mailing Address - Fax:401-621-8691
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3007
Practice Address - Country:US
Practice Address - Phone:401-331-5548
Practice Address - Fax:401-621-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICP00008335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200837OtherBLUE CHIP OF R.I.
RI2959OtherNEIGHBORHOOD HEALTH OF RI
RI9009701Medicaid
RI9701-9OtherBLUE CROSS OF R.I.
RI9009701Medicaid
RI9009701Medicaid