Provider Demographics
NPI:1255338703
Name:KONRAD PROSTHETICS AND ORTHOTICS, INC.
Entity type:Organization
Organization Name:KONRAD PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:KONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:CPO E
Authorized Official - Phone:516-485-9164
Mailing Address - Street 1:596 JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3706
Mailing Address - Country:US
Mailing Address - Phone:516-485-9164
Mailing Address - Fax:516-485-9170
Practice Address - Street 1:596 JENNINGS AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3706
Practice Address - Country:US
Practice Address - Phone:516-485-9164
Practice Address - Fax:516-485-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00376343Medicaid
NYG5336OtherEMPIRE BC/BS
NY96463OtherAETNA
NY=========-002OtherHEALTH FIRST