Provider Demographics
NPI:1356504104
Name:RESTORATIVE PROSTHETICS & ORTHOTICS
Entity type:Organization
Organization Name:RESTORATIVE PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:985-726-9052
Mailing Address - Street 1:168 COMMERCIAL SQ
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5418
Mailing Address - Country:US
Mailing Address - Phone:985-726-9052
Mailing Address - Fax:
Practice Address - Street 1:168 COMMERCIAL SQ
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5418
Practice Address - Country:US
Practice Address - Phone:989-726-9052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6128090002Medicare NSC