Provider Demographics
NPI:1982645289
Name:NEW ENGLAND ORTHOTIC AND PROSTHETIC SYSTEMS, LLC
Entity Type:Organization
Organization Name:NEW ENGLAND ORTHOTIC AND PROSTHETIC SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGANIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-483-8488
Mailing Address - Street 1:22 SUMMIT PL
Mailing Address - Street 2:UNIT 101A
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4111
Mailing Address - Country:US
Mailing Address - Phone:203-483-8488
Mailing Address - Fax:203-483-6085
Practice Address - Street 1:800 NORTHERN BLVD
Practice Address - Street 2:SUITE 3B
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5314
Practice Address - Country:US
Practice Address - Phone:516-829-6188
Practice Address - Fax:516-829-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1223150003Medicare NSC