Provider Demographics
NPI:1467521021
Name:SOMERSET PROSTHETICS AND ORTHOTICS INC
Entity Type:Organization
Organization Name:SOMERSET PROSTHETICS AND ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:HONCHARIK
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:732-560-2830
Mailing Address - Street 1:56 W UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1716
Mailing Address - Country:US
Mailing Address - Phone:732-560-2830
Mailing Address - Fax:732-560-2832
Practice Address - Street 1:56 W UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1716
Practice Address - Country:US
Practice Address - Phone:732-560-2830
Practice Address - Fax:732-560-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0506861OtherAETNA
8427791OtherAETNA
NJ5495300Medicaid
=========0OtherHORIZON BCBS OF NJ
0506861OtherAETNA
=========AOtherHORIZON BCBS OF NJ
NJ5495300Medicaid
0506861OtherAETNA