Provider Demographics
NPI:1467454777
Name:STUART PEDORTHICS, INC.
Entity Type:Organization
Organization Name:STUART PEDORTHICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:LUTWAK
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:818-831-8507
Mailing Address - Street 1:17816 CHATSWORTH ST.
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5611
Mailing Address - Country:US
Mailing Address - Phone:818-831-8507
Mailing Address - Fax:818-831-8527
Practice Address - Street 1:17816 CHATSWORTH ST.
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5611
Practice Address - Country:US
Practice Address - Phone:818-831-8507
Practice Address - Fax:818-831-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0470220001Medicare ID - Type Unspecified