Provider Demographics
NPI:1669442430
Name:ORTHO-BIONICS LABORATORY, INC.
Entity Type:Organization
Organization Name:ORTHO-BIONICS LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:718-845-5572
Mailing Address - Street 1:11442 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1928
Mailing Address - Country:US
Mailing Address - Phone:718-845-5572
Mailing Address - Fax:
Practice Address - Street 1:11442 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1928
Practice Address - Country:US
Practice Address - Phone:718-845-5572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00328496Medicaid
NY0300640001Medicare ID - Type Unspecified