Provider Demographics
NPI:1780841874
Name:THEBRACEDOCTORINC.
Entity Type:Organization
Organization Name:THEBRACEDOCTORINC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VALES
Authorized Official - Suffix:
Authorized Official - Credentials:CO,BOCO,CPED
Authorized Official - Phone:908-966-0620
Mailing Address - Street 1:324 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1046
Mailing Address - Country:US
Mailing Address - Phone:908-966-0620
Mailing Address - Fax:
Practice Address - Street 1:305 E 86TH ST
Practice Address - Street 2:1GW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4702
Practice Address - Country:US
Practice Address - Phone:212-592-3272
Practice Address - Fax:732-495-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-17
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier