Provider Demographics
NPI:1881675155
Name:BAY ORTHOPEDIC AND REHABILITATION SUPPLY CO INC
Entity Type:Organization
Organization Name:BAY ORTHOPEDIC AND REHABILITATION SUPPLY CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGINO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO CPED
Authorized Official - Phone:631-271-0825
Mailing Address - Street 1:616 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 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01014144Medicaid
NY01014144Medicaid