Provider Demographics
NPI:1629046685
Name:EBJ ORTHOTICS & MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:EBJ ORTHOTICS & MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-261-6500
Mailing Address - Street 1:3172 PASEO CRESTA
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3130
Mailing Address - Country:US
Mailing Address - Phone:787-261-6500
Mailing Address - Fax:787-261-3825
Practice Address - Street 1:3172 AVE. DEL VALLE
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-261-6500
Practice Address - Fax:787-261-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1137440001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER