Provider Demographics
NPI:1689744690
Name:DYNAMIC PROSTHETICS INC
Entity Type:Organization
Organization Name:DYNAMIC PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGNAZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCELLIERI
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, BOC OC, ABC OC
Authorized Official - Phone:585-303-1886
Mailing Address - Street 1:186 RED HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4033
Mailing Address - Country:US
Mailing Address - Phone:585-227-0790
Mailing Address - Fax:585-227-8562
Practice Address - Street 1:1401 STONE RD STE 201
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1537
Practice Address - Country:US
Practice Address - Phone:585-227-0790
Practice Address - Fax:585-227-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5173300001Medicare ID - Type UnspecifiedMEDICARE