Provider Demographics
NPI:1902864150
Name:BOSTON BRACE INTERNATIONAL INC.
Entity Type:Organization
Organization Name:BOSTON BRACE INTERNATIONAL INC.
Other - Org Name:BOSTON ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-588-6060
Mailing Address - Street 1:37 SHUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3734
Mailing Address - Country:US
Mailing Address - Phone:508-588-6060
Mailing Address - Fax:508-559-2750
Practice Address - Street 1:3550 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3369
Practice Address - Country:US
Practice Address - Phone:215-634-9399
Practice Address - Fax:267-787-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4532848OtherAETNA NON HMO
203318OtherBLUE CROSS KHPE
NJ3537901Medicaid
PA6321880002Medicaid
006759OtherAETNA HMO
60008DMOtherKEYSTONE MERCY
203318OtherBLUE CROSS KHPE