Provider Demographics
NPI:1952306144
Name:CLINICAL PROSTHETICS & ORTHOTICS, LLC
Entity Type:Organization
Organization Name:CLINICAL PROSTHETICS & ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MISENER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:518-432-0683
Mailing Address - Street 1:144 PINE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4946
Mailing Address - Country:US
Mailing Address - Phone:845-336-7762
Mailing Address - Fax:845-336-7763
Practice Address - Street 1:144 PINE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4946
Practice Address - Country:US
Practice Address - Phone:845-336-7762
Practice Address - Fax:845-336-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02998112Medicaid
NY4197220001Medicare NSC