Provider Demographics
NPI:1487359832
Name:BEVERLY ORTHOPEDIC LABORATORY INC.
Entity type:Organization
Organization Name:BEVERLY ORTHOPEDIC LABORATORY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAWANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCPO
Authorized Official - Phone:323-727-2887
Mailing Address - Street 1:2625 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-0031
Mailing Address - Country:US
Mailing Address - Phone:323-727-2887
Mailing Address - Fax:323-727-2854
Practice Address - Street 1:4150 LATHAM STREET SUITE:G
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-0001
Practice Address - Country:US
Practice Address - Phone:951-742-5127
Practice Address - Fax:951-742-5184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERLY ORTHOPEDIC LABORATORY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy