Provider Demographics
NPI:1023286762
Name:MODERN REHABILITATION TECHNOLOGIES, LLC
Entity type:Organization
Organization Name:MODERN REHABILITATION TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHWING
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO, BOCPO
Authorized Official - Phone:561-748-5657
Mailing Address - Street 1:329 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2830
Mailing Address - Country:US
Mailing Address - Phone:631-360-6400
Mailing Address - Fax:631-360-6449
Practice Address - Street 1:430 TONEY PENNA DR
Practice Address - Street 2:SUITE 6
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5775
Practice Address - Country:US
Practice Address - Phone:561-748-5657
Practice Address - Fax:561-748-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR 170335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4146880002Medicare NSC