Provider Demographics
NPI:1104049428
Name:BAY ORTHOPEDIC AND REHABILITATION SUPPLY COMPANY, INC
Entity type:Organization
Organization Name:BAY ORTHOPEDIC AND REHABILITATION SUPPLY COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGINO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, CPED
Authorized Official - Phone:631-271-0825
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4938
Mailing Address - Country:US
Mailing Address - Phone:516-333-7200
Mailing Address - Fax:516-333-7277
Practice Address - Street 1:651 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4938
Practice Address - Country:US
Practice Address - Phone:516-333-7200
Practice Address - Fax:516-333-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01014144Medicaid
NY01014144Medicaid