Provider Demographics
NPI:1710416110
Name:VARELA, WILLIAM (CPO,LPO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VARELA
Suffix:
Gender:M
Credentials:CPO,LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOCKHOCKSON
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4414
Mailing Address - Country:US
Mailing Address - Phone:908-915-3833
Mailing Address - Fax:732-460-0949
Practice Address - Street 1:200 HOCKHOCKSON ROAD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:908-915-3833
Practice Address - Fax:732-460-0949
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00003200335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ45PO00003200OtherPROSTHETIST/ORTHOTIST NUMBER