Provider Demographics
NPI:1801076815
Name:KLEMMT ORTHO & PROST. INC.
Entity type:Organization
Organization Name:KLEMMT ORTHO & PROST. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:F
Authorized Official - Last Name:KLEMMT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:607-770-4400
Mailing Address - Street 1:130 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1758
Mailing Address - Country:US
Mailing Address - Phone:607-770-4400
Mailing Address - Fax:607-770-4422
Practice Address - Street 1:130 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1758
Practice Address - Country:US
Practice Address - Phone:607-770-4400
Practice Address - Fax:607-770-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00435204Medicaid
NY0237740001Medicare NSC