Provider Demographics
NPI:1720063555
Name:NATIONAL PROSTHETIC ORTHOTIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:NATIONAL PROSTHETIC ORTHOTIC ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ONEL
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PROSTHETIST
Authorized Official - Phone:718-423-8700
Mailing Address - Street 1:21441 42ND AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2963
Mailing Address - Country:US
Mailing Address - Phone:718-423-8700
Mailing Address - Fax:718-423-8708
Practice Address - Street 1:21441 42ND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2963
Practice Address - Country:US
Practice Address - Phone:718-423-8700
Practice Address - Fax:718-423-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP-1113335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01115099Medicaid
NY01115099Medicaid