Provider Demographics
NPI:1104977081
Name:ORTHOMED APPLIANCES INC
Entity type:Organization
Organization Name:ORTHOMED APPLIANCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-656-1442
Mailing Address - Street 1:7900 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5108
Mailing Address - Country:US
Mailing Address - Phone:323-656-1442
Mailing Address - Fax:323-656-1516
Practice Address - Street 1:7900 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5108
Practice Address - Country:US
Practice Address - Phone:323-656-1442
Practice Address - Fax:323-656-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B0000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00446FMedicaid
CADME00446FMedicaid