Provider Demographics
NPI:1194896993
Name:PISANI'S ORTHOTICS AND PROSTHETICS, INC.
Entity type:Organization
Organization Name:PISANI'S ORTHOTICS AND PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PISANI
Authorized Official - Suffix:
Authorized Official - Credentials:LOP
Authorized Official - Phone:561-433-1556
Mailing Address - Street 1:3208 2ND AVE N
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3682
Mailing Address - Country:US
Mailing Address - Phone:561-433-1556
Mailing Address - Fax:561-433-5298
Practice Address - Street 1:3208 2ND AVE N
Practice Address - Street 2:SUITE 5
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3682
Practice Address - Country:US
Practice Address - Phone:561-433-1556
Practice Address - Fax:561-433-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR 106335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL205649OtherAMERIGROUP
FL64688OtherAPB
FL950785000Medicaid
FLM2498OtherBLUE CROSS BLUE SHIELD
FL104516OtherAVMED
FLM2100OtherBLUE CROSS BLUE SHIELD
FL51148OtherABP
FL7165406OtherAETNA
FLSG027999OtherVISTA MEDICARE
FL168999OtherHEALTHEASE
FL820076OtherPCA
FLA101300OtherPHYSICIANS HEALTH CARE
FL64688OtherAPB
FL=========OtherHUMANA
FL=========OtherCHAMPUS
FL104516OtherAVMED
FLM2100OtherBLUE CROSS BLUE SHIELD
FL51148OtherABP