Provider Demographics
NPI:1578134359
Name:ORTHOTIC AND PROSTHETIC CLINICS OF AMERICA
Entity Type:Organization
Organization Name:ORTHOTIC AND PROSTHETIC CLINICS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, RN
Authorized Official - Phone:203-777-2396
Mailing Address - Street 1:627 CHAPEL STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-777-2396
Mailing Address - Fax:203-782-4966
Practice Address - Street 1:4809 MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634
Practice Address - Country:US
Practice Address - Phone:888-424-1620
Practice Address - Fax:203-782-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier