Provider Demographics
NPI:1811041130
Name:LORELEI ORTHOTICS AND PROSTHETICS, INC.
Entity Type:Organization
Organization Name:LORELEI ORTHOTICS AND PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:WESTLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:212-727-2011
Mailing Address - Street 1:19 W 21ST ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6805
Mailing Address - Country:US
Mailing Address - Phone:212-727-2011
Mailing Address - Fax:212-727-0844
Practice Address - Street 1:19 W 21ST ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6805
Practice Address - Country:US
Practice Address - Phone:212-727-2011
Practice Address - Fax:212-727-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1046705Medicaid
NY01091818Medicaid