Provider Demographics
NPI:1407025224
Name:HOWARD ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:HOWARD ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VPA/INCOME MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-786-8973
Mailing Address - Street 1:316 SHERMAN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2729
Mailing Address - Country:US
Mailing Address - Phone:315-786-8973
Mailing Address - Fax:315-786-7993
Practice Address - Street 1:316 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3614
Practice Address - Country:US
Practice Address - Phone:315-786-0655
Practice Address - Fax:315-786-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02386432Medicaid
NY4697030001OtherMEDICARE DMERC
NY02386432Medicaid
NY4697030001Medicare PIN