Provider Demographics
NPI:1417119140
Name:BIOTECH INDUSTRIES
Entity Type:Organization
Organization Name:BIOTECH INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GHIZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:CP LPO
Authorized Official - Phone:973-299-7071
Mailing Address - Street 1:420 BOULEVARD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1742
Mailing Address - Country:US
Mailing Address - Phone:973-299-7071
Mailing Address - Fax:973-299-7073
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE 207
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:973-299-7071
Practice Address - Fax:973-299-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0047112Medicaid
NJ0047112Medicaid