Provider Demographics
NPI:1467445783
Name:ORTHO-PRO BIOMECHANICS GROUP, INC.
Entity Type:Organization
Organization Name:ORTHO-PRO BIOMECHANICS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-358-6008
Mailing Address - Street 1:394 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2334
Mailing Address - Country:US
Mailing Address - Phone:516-539-6070
Mailing Address - Fax:516-539-6075
Practice Address - Street 1:394 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2334
Practice Address - Country:US
Practice Address - Phone:516-539-6070
Practice Address - Fax:516-539-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN/A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01252560Medicaid
NY0824540001Medicare NSC