Provider Demographics
NPI:1619043932
Name:JK PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:JK PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-699-2077
Mailing Address - Street 1:699 N MACQUESTEN PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2121
Mailing Address - Country:US
Mailing Address - Phone:914-699-2077
Mailing Address - Fax:914-699-0676
Practice Address - Street 1:699 N MACQUESTEN PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2121
Practice Address - Country:US
Practice Address - Phone:914-699-2077
Practice Address - Fax:914-699-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0187070001Medicare NSC