Provider Demographics
NPI:1447592654
Name:PROSTHETIC CARE SERVICES 'PROCARE' INC.,
Entity Type:Organization
Organization Name:PROSTHETIC CARE SERVICES 'PROCARE' INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEWPERSAUD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADHO
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:518-370-3005
Mailing Address - Street 1:1479 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2525
Mailing Address - Country:US
Mailing Address - Phone:518-370-3005
Mailing Address - Fax:
Practice Address - Street 1:1479 PARKWOOD BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2525
Practice Address - Country:US
Practice Address - Phone:518-370-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP003663335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY400208856001OtherCDPHP
NY400208856001OtherCDPHP
NY6378390001Medicare UPIN