Provider Demographics
NPI:1659706992
Name:ATLANTIC PROSTHETIC & ORTHOTIC SERVICES, INC.
Entity Type:Organization
Organization Name:ATLANTIC PROSTHETIC & ORTHOTIC SERVICES, INC.
Other - Org Name:ATPRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:609-927-6330
Mailing Address - Street 1:199 NEW RD
Mailing Address - Street 2:SUITE 57
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2025
Mailing Address - Country:US
Mailing Address - Phone:609-927-6330
Mailing Address - Fax:609-927-6366
Practice Address - Street 1:376 EAST WHEAT ROAD
Practice Address - Street 2:SUITE 4-D
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08341
Practice Address - Country:US
Practice Address - Phone:856-535-1106
Practice Address - Fax:609-927-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0591651335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5417406Medicaid
NJ1528060829Medicare PIN