Provider Demographics
NPI:1851882914
Name:EASTWOOD, MICHAEL ROBERT (CERIFIED ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:EASTWOOD
Suffix:
Gender:M
Credentials:CERIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7317
Mailing Address - Country:US
Mailing Address - Phone:631-271-0825
Mailing Address - Fax:631-271-1363
Practice Address - Street 1:616 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7317
Practice Address - Country:US
Practice Address - Phone:631-271-0825
Practice Address - Fax:631-271-1363
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist