Provider Demographics
NPI:1497743983
Name:ENABLE ORTHOTICS & PROSTHETICS, LLC.
Entity Type:Organization
Organization Name:ENABLE ORTHOTICS & PROSTHETICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:GENERAL MANAGER
Authorized Official - Phone:315-701-5712
Mailing Address - Street 1:521 E. WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1917
Mailing Address - Country:US
Mailing Address - Phone:315-701-5712
Mailing Address - Fax:315-701-5713
Practice Address - Street 1:521 E. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1917
Practice Address - Country:US
Practice Address - Phone:315-701-5712
Practice Address - Fax:315-701-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5329240001Medicare NSC