Provider Demographics
NPI:1922273671
Name:CENTIPEDE'S O&P LLC
Entity Type:Organization
Organization Name:CENTIPEDE'S O&P LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:OKIN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:718-490-6830
Mailing Address - Street 1:PO BOX 190325
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-0325
Mailing Address - Country:US
Mailing Address - Phone:718-484-1700
Mailing Address - Fax:718-484-1707
Practice Address - Street 1:4210 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1335
Practice Address - Country:US
Practice Address - Phone:718-484-1700
Practice Address - Fax:718-484-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03082684Medicaid
NY03082684Medicaid