Provider Demographics
NPI:1215067756
Name:CARE CRAFTERS PROSTHETICS & ORTHOTICS, INC
Entity type:Organization
Organization Name:CARE CRAFTERS PROSTHETICS & ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DRYGAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO FAAOP
Authorized Official - Phone:845-426-6900
Mailing Address - Street 1:95 NEW CLARKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5203
Mailing Address - Country:US
Mailing Address - Phone:845-426-6900
Mailing Address - Fax:845-426-6926
Practice Address - Street 1:95 NEW CLARKSTOWN RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5203
Practice Address - Country:US
Practice Address - Phone:845-426-6900
Practice Address - Fax:845-426-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00013300222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVION3P0506OtherVETERANS ADMINISTRATION
NJ8586501Medicaid
NY9602046OtherGHI PROVIDER NUMBER
NYA398916OtherOXFORD PROVIDER NUMBER
NY01703433Medicaid
NY288276OtherWELLCARE PROVIDER NUMBER
NY288276OtherWELLCARE PROVIDER NUMBER