Provider Demographics
NPI:1750844239
Name:ADVANCE PROSTHETIC AND ORTHOTIC INC
Entity Type:Organization
Organization Name:ADVANCE PROSTHETIC AND ORTHOTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEWS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-317-3443
Mailing Address - Street 1:51 CURTMANTLE RD
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1263
Mailing Address - Country:US
Mailing Address - Phone:201-317-3442
Mailing Address - Fax:201-353-2343
Practice Address - Street 1:111 DEAN DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2764
Practice Address - Country:US
Practice Address - Phone:201-429-6960
Practice Address - Fax:201-429-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty