Provider Demographics
NPI:1295797090
Name:JEFFERSON ORTHOTICS & PROSTHETICS LLC
Entity type:Organization
Organization Name:JEFFERSON ORTHOTICS & PROSTHETICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUNSERI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-347-2324
Mailing Address - Street 1:909 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3123
Mailing Address - Country:US
Mailing Address - Phone:504-347-2324
Mailing Address - Fax:504-347-2341
Practice Address - Street 1:909 AVENUE C
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3123
Practice Address - Country:US
Practice Address - Phone:504-347-2324
Practice Address - Fax:504-347-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA435810332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1959821Medicaid
LA0236300003Medicare ID - Type UnspecifiedDME, ORTHOPEDIC, PROSTHET
LA7436550001Medicare NSC