Provider Demographics
NPI:1780873083
Name:PRO-FIT LLC
Entity type:Organization
Organization Name:PRO-FIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, FAAOP
Authorized Official - Phone:856-809-9910
Mailing Address - Street 1:215 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091
Mailing Address - Country:US
Mailing Address - Phone:856-809-9910
Mailing Address - Fax:856-809-9945
Practice Address - Street 1:215 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091
Practice Address - Country:US
Practice Address - Phone:856-809-9910
Practice Address - Fax:856-809-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO0015100335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8664609Medicaid
NJ2657725OtherAETNA
NJ2657725OtherAETNA
NJ4191480001Medicare NSC
4191480001Medicare PIN