Provider Demographics
NPI:1922279454
Name:ORTHOTICS AND PROSTHETICS SOLUTIONS
Entity Type:Organization
Organization Name:ORTHOTICS AND PROSTHETICS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-827-0130
Mailing Address - Street 1:101 BLOOMINGDALE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6550
Mailing Address - Country:US
Mailing Address - Phone:516-827-0130
Mailing Address - Fax:516-827-0133
Practice Address - Street 1:101 BLOOMINGDALE RD
Practice Address - Street 2:STE 2
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6550
Practice Address - Country:US
Practice Address - Phone:516-827-0130
Practice Address - Fax:516-827-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCO002078332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6136160001Medicare NSC