Provider Demographics
NPI:1427010669
Name:ORTHO BRACING SYSTEMS LTD
Entity Type:Organization
Organization Name:ORTHO BRACING SYSTEMS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CICATELLI
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED ORTHOTIST
Authorized Official - Phone:845-528-1942
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-0229
Mailing Address - Country:US
Mailing Address - Phone:845-528-1942
Mailing Address - Fax:845-528-1942
Practice Address - Street 1:11 FLORENCE RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3423
Practice Address - Country:US
Practice Address - Phone:845-528-1942
Practice Address - Fax:845-528-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01022540Medicaid
NY014505OtherAETNA
NY01022540Medicaid