Provider Demographics
NPI:1629392949
Name:ORTHOTECH EXPRESS CORP
Entity Type:Organization
Organization Name:ORTHOTECH EXPRESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUPOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-277-1390
Mailing Address - Street 1:67 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2340
Mailing Address - Country:US
Mailing Address - Phone:516-277-1390
Mailing Address - Fax:516-277-1389
Practice Address - Street 1:67 MEADOW LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2340
Practice Address - Country:US
Practice Address - Phone:516-277-1390
Practice Address - Fax:516-277-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies