Provider Demographics
NPI:1700866555
Name:ORTHOTIC CONSULTANTS INC
Entity Type:Organization
Organization Name:ORTHOTIC CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMIN OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:ERICA
Authorized Official - Last Name:RAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:ABC CERT ORTHOTIST
Authorized Official - Phone:212-315-2320
Mailing Address - Street 1:119 WEST 57 STREET
Mailing Address - Street 2:SUITE 1514
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2301
Mailing Address - Country:US
Mailing Address - Phone:212-315-2320
Mailing Address - Fax:212-262-1656
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 1514
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-315-2320
Practice Address - Fax:212-262-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00320118Medicaid
NY00320118Medicaid