Provider Demographics
NPI:1013488469
Name:PRO MED PROSTHETICS & ORTHOTICS LLC
Entity Type:Organization
Organization Name:PRO MED PROSTHETICS & ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PLOSZAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-982-8542
Mailing Address - Street 1:340 BROAD ST STE 320
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3030
Mailing Address - Country:US
Mailing Address - Phone:860-298-9900
Mailing Address - Fax:860-298-9911
Practice Address - Street 1:340 BROAD ST STE 320
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3030
Practice Address - Country:US
Practice Address - Phone:860-298-9900
Practice Address - Fax:860-298-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty