Provider Demographics
NPI:1881913630
Name:ALL COUNTY ORTHOTICS AND PROSTHETICS, INC .
Entity type:Organization
Organization Name:ALL COUNTY ORTHOTICS AND PROSTHETICS, INC .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:516-349-7588
Mailing Address - Street 1:1055 STEWART AVE
Mailing Address - Street 2:2ND FLOOR, SUITE 1
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3596
Mailing Address - Country:US
Mailing Address - Phone:516-349-7588
Mailing Address - Fax:516-349-7585
Practice Address - Street 1:1055 STEWART AVE
Practice Address - Street 2:2ND FLOOR, SUITE 1
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3596
Practice Address - Country:US
Practice Address - Phone:516-349-7588
Practice Address - Fax:516-349-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCO004271335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6636440001Medicare NSC