Provider Demographics
NPI:1487608311
Name:MODERN LIMB & BRACE CO.
Entity type:Organization
Organization Name:MODERN LIMB & BRACE CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HORST
Authorized Official - Middle Name:
Authorized Official - Last Name:OERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:908-757-2702
Mailing Address - Street 1:916 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6305
Mailing Address - Country:US
Mailing Address - Phone:908-757-2702
Mailing Address - Fax:908-757-0744
Practice Address - Street 1:916 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6305
Practice Address - Country:US
Practice Address - Phone:908-757-2702
Practice Address - Fax:908-757-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2758OtherLIBERTY HEALTH PLANS
NJ555663OtherPMSI
NJ0003963000OtherAMERIHEALTH
NJSO000006600OtherAMERICHOICE
NJ2K1884OtherHEALTHNET
NJ040045OtherAETNA
NJ10540304OtherGUARDIAN
NJ2784203Medicaid
NJ1066390OtherHORIZON NJ HEALTH
NJ1487608311OtherHORIZON BCBS
NJ260248900OtherACS - US DEPT LABOR
NJ260248900OtherSTATE OF NJ - WORKERS COMP
NJA522677OtherOXFORD
NJSO000006600OtherAMERICHOICE