Provider Demographics
NPI:1285129205
Name:TRISETO ORTHOTIC SOLUTIONS, INC.
Entity type:Organization
Organization Name:TRISETO ORTHOTIC SOLUTIONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:516-837-3177
Mailing Address - Street 1:2 LAWSON AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1700
Mailing Address - Country:US
Mailing Address - Phone:516-837-3177
Mailing Address - Fax:212-879-5175
Practice Address - Street 1:2 LAWSON AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1700
Practice Address - Country:US
Practice Address - Phone:516-837-3177
Practice Address - Fax:212-879-5175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR335335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier