Provider Demographics
NPI:1215065628
Name:HUYSMAN ORTHOTICS LTD.
Entity type:Organization
Organization Name:HUYSMAN ORTHOTICS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST-ORTHOTIST PR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:HUYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:631-878-8864
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-0202
Mailing Address - Country:US
Mailing Address - Phone:631-878-8864
Mailing Address - Fax:631-878-0919
Practice Address - Street 1:494 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-0202
Practice Address - Country:US
Practice Address - Phone:631-878-8864
Practice Address - Fax:631-878-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00820140Medicaid
NY4126230001Medicare ID - Type Unspecified