Provider Demographics
NPI:1578763579
Name:ADVANCED ORTHOTICS AND PROSTHETICS TECHNOLOGIES LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOTICS AND PROSTHETICS TECHNOLOGIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VAN HOOF
Authorized Official - Suffix:II
Authorized Official - Credentials:CPO
Authorized Official - Phone:203-740-8952
Mailing Address - Street 1:12 FAWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3803
Mailing Address - Country:US
Mailing Address - Phone:203-740-8952
Mailing Address - Fax:
Practice Address - Street 1:133-135 SOUTH ST.
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-798-7616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCPO 1530335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier