Provider Demographics
NPI:1629283452
Name:ORTHO MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:ORTHO MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-746-0556
Mailing Address - Street 1:210 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1701
Mailing Address - Country:US
Mailing Address - Phone:516-746-0556
Mailing Address - Fax:516-741-4738
Practice Address - Street 1:123 SARATOGA ROAD
Practice Address - Street 2:BUILDING 2 UNIT 6
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-4181
Practice Address - Country:US
Practice Address - Phone:516-746-0556
Practice Address - Fax:518-631-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01988081Medicaid
NY01988081Medicaid