Provider Demographics
NPI:1821248485
Name:ORTHOLOGIX, LLC
Entity Type:Organization
Organization Name:ORTHOLOGIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-651-1510
Mailing Address - Street 1:2655 INTERPLEX DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6947
Mailing Address - Country:US
Mailing Address - Phone:215-244-4100
Mailing Address - Fax:
Practice Address - Street 1:2301 EVESHAM ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-651-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1140246335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4843880002Medicare NSC