Provider Demographics
NPI:1871853101
Name:MODERN LIMB & BRACE CO INC
Entity Type:Organization
Organization Name:MODERN LIMB & BRACE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CP,LPO
Authorized Official - Prefix:MR
Authorized Official - First Name:HORST
Authorized Official - Middle Name:H
Authorized Official - Last Name:OERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:908-757-2702
Mailing Address - Street 1:916 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6305
Mailing Address - Country:US
Mailing Address - Phone:908-757-2702
Mailing Address - Fax:908-757-0744
Practice Address - Street 1:916 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6305
Practice Address - Country:US
Practice Address - Phone:908-757-2702
Practice Address - Fax:908-757-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00004800335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier