Provider Demographics
NPI:1649919010
Name:ORTHOTIC & PROSTHETIC ARTS
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALTAGRACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA-ATRISTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:347-232-1464
Mailing Address - Street 1:13 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2803
Mailing Address - Country:US
Mailing Address - Phone:845-459-0212
Mailing Address - Fax:845-669-0152
Practice Address - Street 1:450 WESTERN HWY STE A
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2188
Practice Address - Country:US
Practice Address - Phone:845-459-0212
Practice Address - Fax:845-669-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier