Provider Demographics
NPI:1891095873
Name:ARTISAN ORTHOTIC & PROSTHETIC SERVICES, INC.
Entity Type:Organization
Organization Name:ARTISAN ORTHOTIC & PROSTHETIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA-ATRISTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:646-410-2001
Mailing Address - Street 1:13 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2803
Mailing Address - Country:US
Mailing Address - Phone:347-232-1464
Mailing Address - Fax:
Practice Address - Street 1:3 E 115TH ST
Practice Address - Street 2:CS1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1088
Practice Address - Country:US
Practice Address - Phone:646-410-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies