Provider Demographics
NPI:1942431853
Name:STRIDE ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:STRIDE ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:EMPIRE ORTHOPEDIC LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:315-430-5136
Mailing Address - Street 1:44 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13495-1324
Mailing Address - Country:US
Mailing Address - Phone:315-736-0161
Mailing Address - Fax:315-736-0570
Practice Address - Street 1:44 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:NY
Practice Address - Zip Code:13495-1324
Practice Address - Country:US
Practice Address - Phone:315-736-0161
Practice Address - Fax:315-736-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6272020001Medicare NSC