Provider Demographics
NPI:1396985297
Name:NEW STEP ORTHOTIC LAB, INC
Entity type:Organization
Organization Name:NEW STEP ORTHOTIC LAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/SEC
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:618-288-9297
Mailing Address - Street 1:4225 S STATE ROUTE 159
Mailing Address - Street 2:STE 1
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3231
Mailing Address - Country:US
Mailing Address - Phone:618-288-9297
Mailing Address - Fax:
Practice Address - Street 1:4225 S STATE ROUTE 159
Practice Address - Street 2:STE 1
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3231
Practice Address - Country:US
Practice Address - Phone:618-288-9297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL212.000142335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6181180001Medicare NSC