Provider Demographics
NPI:1669040960
Name:PERFORMANCE ORTHOPEDIC DESIGN, LLC
Entity Type:Organization
Organization Name:PERFORMANCE ORTHOPEDIC DESIGN, LLC
Other - Org Name:MOUNTAIN ORTHOTIC & PROSTHETIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CPO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERENSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-523-2419
Mailing Address - Street 1:7 OLD MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1614
Mailing Address - Country:US
Mailing Address - Phone:518-523-2419
Mailing Address - Fax:518-523-7192
Practice Address - Street 1:70 CONSTABLE ST FL 1
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1324
Practice Address - Country:US
Practice Address - Phone:518-521-3257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFORMANCE ORTHOPEDIC DESIGN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier