Provider Demographics
NPI:1952488470
Name:PRO FIT PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:PRO FIT PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO FAAOP
Authorized Official - Phone:856-374-8006
Mailing Address - Street 1:901 ROUTE 168
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-374-8006
Mailing Address - Fax:856-374-0169
Practice Address - Street 1:901 ROUTE 168
Practice Address - Street 2:SUITE 410
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-374-8006
Practice Address - Fax:856-374-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00015100335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
64577OtherAMERIGROUP
2657725OtherAETNA
0005171000OtherAMERIHEALTH GROUP
NJ117308OtherHORIZON NJ HEALTH
0005171000OtherINDEPENDENCE BLUE CROSS
2K1903OtherHEALTHNET
NJ8664609Medicaid
2K1903OtherHEALTHNET
NJ=========OtherHORIZON
0005171000OtherINDEPENDENCE BLUE CROSS
NJ=========OtherHORIZON CASUALTY SERVICES
=========OtherTHREE RIVERS
NJ=========OtherNEW JERSEY CARPENTERS FUN
NJ8664609Medicaid
NJ=========OtherNEW JERSEY CARPENTERS FUN