Provider Demographics
NPI:1982881983
Name:MANCHESTER ORTHOPEDIC INC.
Entity Type:Organization
Organization Name:MANCHESTER ORTHOPEDIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:718-925-2922
Mailing Address - Street 1:365 ROUTE 59 STE 214
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3459
Mailing Address - Country:US
Mailing Address - Phone:718-925-2922
Mailing Address - Fax:718-925-2232
Practice Address - Street 1:365 ROUTE 59 STE 214
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3459
Practice Address - Country:US
Practice Address - Phone:718-925-2922
Practice Address - Fax:718-925-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332BC3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00368350Medicaid
NY1578653085OtherINDIVIDUAL NPI NUMBER
NY0259370001Medicare NSC