Provider Demographics
NPI:1669560736
Name:ADVANTAGE ORTHOTICS AND PROSTHETICS INC
Entity type:Organization
Organization Name:ADVANTAGE ORTHOTICS AND PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KETCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:631-368-1754
Mailing Address - Street 1:337 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-368-1754
Mailing Address - Fax:631-486-4502
Practice Address - Street 1:337 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731
Practice Address - Country:US
Practice Address - Phone:631-368-1754
Practice Address - Fax:631-486-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6997140OtherCIGNA
NY1231286OtherAETNA
NY1231286OtherAETNA