Provider Demographics
NPI:1396146387
Name:ATLANTIC PROSTHETIC & ORTHOTIC
Entity type:Organization
Organization Name:ATLANTIC PROSTHETIC & ORTHOTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:CO/BOCO
Authorized Official - Phone:609-364-5001
Mailing Address - Street 1:199 NEW RD
Mailing Address - Street 2:SUITE 57
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2025
Mailing Address - Country:US
Mailing Address - Phone:609-927-6330
Mailing Address - Fax:609-927-6366
Practice Address - Street 1:69 CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1369
Practice Address - Country:US
Practice Address - Phone:609-927-6330
Practice Address - Fax:609-927-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5417406Medicaid
NJ0599580001Medicare NSC