Provider Demographics
NPI:1194291575
Name:PHILADELPHIA ORTHOTICS AND PROSTHETICS, INC.
Entity type:Organization
Organization Name:PHILADELPHIA ORTHOTICS AND PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/LPO
Authorized Official - Phone:856-428-4201
Mailing Address - Street 1:709 SOMERDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1313
Mailing Address - Country:US
Mailing Address - Phone:856-428-4201
Mailing Address - Fax:856-428-4204
Practice Address - Street 1:709 SOMERDALE ROAD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1313
Practice Address - Country:US
Practice Address - Phone:856-428-4201
Practice Address - Fax:856-428-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3549500Medicaid
PA0009100060002Medicaid