Provider Demographics
NPI:1457358350
Name:ORTHOLOGIX, LLC
Entity Type:Organization
Organization Name:ORTHOLOGIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-244-4100
Mailing Address - Street 1:2655 INTERPLEX DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6947
Mailing Address - Country:US
Mailing Address - Phone:215-244-4100
Mailing Address - Fax:215-244-4114
Practice Address - Street 1:2655 INTERPLEX DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6947
Practice Address - Country:US
Practice Address - Phone:215-244-4100
Practice Address - Fax:215-244-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006239335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019598990001Medicaid
PA1534119OtherHIGHMARK
PA0007120528OtherAETNA
DE1000025967Medicaid
NJ0013757Medicaid
PA0002189000OtherINDEPENDENCE BLUE CROSS
NY02499829Medicaid
PA1534119OtherHIGHMARK
PA4843880001Medicare ID - Type Unspecified
PA0019598990001Medicaid