Provider Demographics
NPI:1386458255
Name:PROSTHETICS IN MOTION MELVILLE, LLC
Entity type:Organization
Organization Name:PROSTHETICS IN MOTION MELVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:KORT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:516-474-4124
Mailing Address - Street 1:1860 WALT WHITMAN RD STE 750
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3098
Mailing Address - Country:US
Mailing Address - Phone:516-474-4124
Mailing Address - Fax:
Practice Address - Street 1:1860 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3282
Practice Address - Country:US
Practice Address - Phone:516-474-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier