Provider Demographics
NPI:1508840141
Name:CHOICE LIMB & BRACE
Entity Type:Organization
Organization Name:CHOICE LIMB & BRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO CRED
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SQUICCIARINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-479-0743
Mailing Address - Street 1:555A S COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4731
Mailing Address - Country:US
Mailing Address - Phone:914-479-0743
Mailing Address - Fax:914-479-1568
Practice Address - Street 1:555A S COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4731
Practice Address - Country:US
Practice Address - Phone:914-479-0743
Practice Address - Fax:914-479-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1230265332BC3200X
NY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY412358224OtherHEALTH PLUS
NYA2540663OtherOXFORD
NY02215167Medicaid