Provider Demographics
NPI:1497840490
Name:MODERN LIMB AND BRACE CO
Entity Type:Organization
Organization Name:MODERN LIMB AND BRACE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-455-6878
Mailing Address - Street 1:5310 RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-3031
Mailing Address - Country:US
Mailing Address - Phone:215-455-6878
Mailing Address - Fax:215-455-8560
Practice Address - Street 1:5310 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19120-3031
Practice Address - Country:US
Practice Address - Phone:215-455-6878
Practice Address - Fax:215-455-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0002647000OtherBLUE CROSS
PA0002647000OtherBLUE CROSS