Provider Demographics
NPI:1538315403
Name:CENTER FOR PROSTHETICS AND
Entity Type:Organization
Organization Name:CENTER FOR PROSTHETICS AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PAULOSE
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTIST
Authorized Official - Phone:914-715-6010
Mailing Address - Street 1:5674 MOSHOLU AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:914-715-6010
Mailing Address - Fax:718-796-7180
Practice Address - Street 1:5650 MOSHOLU AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:914-715-6010
Practice Address - Fax:718-796-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1307460001Medicare NSC