Provider Demographics
NPI:1407223134
Name:JB ORTHOTICS CORP
Entity Type:Organization
Organization Name:JB ORTHOTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-554-5217
Mailing Address - Street 1:1005 NE 125TH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5810
Mailing Address - Country:US
Mailing Address - Phone:877-554-5217
Mailing Address - Fax:
Practice Address - Street 1:1005 NE 125TH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5810
Practice Address - Country:US
Practice Address - Phone:877-554-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies