Provider Demographics
NPI:1922188176
Name:CREATIVE ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:CREATIVE ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-733-5280
Mailing Address - Street 1:100 JOHN ROEMMELT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8301
Mailing Address - Country:US
Mailing Address - Phone:607-796-5906
Mailing Address - Fax:607-796-5908
Practice Address - Street 1:100 JOHN ROEMMELT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-796-5906
Practice Address - Fax:607-796-5908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPH'S HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02604337Medicaid
NY02604337Medicaid