Provider Demographics
NPI:1780651182
Name:NORTH SHORE ORTHOTICS-PROSTHETICS, LTD
Entity Type:Organization
Organization Name:NORTH SHORE ORTHOTICS-PROSTHETICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-928-3040
Mailing Address - Street 1:4551 SUNRISE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4637
Mailing Address - Country:US
Mailing Address - Phone:631-928-3040
Mailing Address - Fax:631-474-8020
Practice Address - Street 1:4551 SUNRISE HWY STE 2
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4637
Practice Address - Country:US
Practice Address - Phone:631-928-3040
Practice Address - Fax:631-474-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier