Provider Demographics
NPI:1417584046
Name:ALTA VISTA INC.
Entity Type:Organization
Organization Name:ALTA VISTA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PISACRETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-331-1770
Mailing Address - Street 1:420 MADISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1195
Mailing Address - Country:US
Mailing Address - Phone:212-883-6620
Mailing Address - Fax:
Practice Address - Street 1:420 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1195
Practice Address - Country:US
Practice Address - Phone:212-883-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier