Provider Demographics
NPI:1487191862
Name:NORTHEAST ORTHOTICS INC.
Entity Type:Organization
Organization Name:NORTHEAST ORTHOTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAVLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:CO, CPED, CFO
Authorized Official - Phone:215-868-7120
Mailing Address - Street 1:2326 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4321
Mailing Address - Country:US
Mailing Address - Phone:215-868-7120
Mailing Address - Fax:267-818-1068
Practice Address - Street 1:3223 N BROAD ST STE 150
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:215-707-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOH000284335E00000X
PAPD000109335E00000X
PAOF000151335E00000X
NJ45PD00001000335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier