Provider Demographics
NPI:1649241324
Name:CERTIFIED ORTHOPEDIC, CO. INC
Entity type:Organization
Organization Name:CERTIFIED ORTHOPEDIC, CO. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:718-338-1904
Mailing Address - Street 1:612 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7317
Mailing Address - Country:US
Mailing Address - Phone:718-338-1904
Mailing Address - Fax:718-258-1122
Practice Address - Street 1:612 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7317
Practice Address - Country:US
Practice Address - Phone:718-338-1904
Practice Address - Fax:718-258-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00320705Medicaid
NY00320705Medicaid