Provider Demographics
NPI:1952141251
Name:E&G PROSTHETICS AND ORTHOTICS, LLC
Entity type:Organization
Organization Name:E&G PROSTHETICS AND ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHAGIAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:917-832-6454
Mailing Address - Street 1:2305 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4345
Mailing Address - Country:US
Mailing Address - Phone:917-832-6454
Mailing Address - Fax:917-832-6640
Practice Address - Street 1:1546 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4551
Practice Address - Country:US
Practice Address - Phone:917-717-4607
Practice Address - Fax:917-717-8894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:E&G PROSTHETICS AND ORTHOTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier