Provider Demographics
NPI:1487733135
Name:PRESQUE ISLE ORTHOPEDIC LABORATORY INC.
Entity type:Organization
Organization Name:PRESQUE ISLE ORTHOPEDIC LABORATORY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIFETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-838-0099
Mailing Address - Street 1:2440 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4428
Mailing Address - Country:US
Mailing Address - Phone:814-838-2349
Mailing Address - Fax:814-835-8042
Practice Address - Street 1:2440 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4428
Practice Address - Country:US
Practice Address - Phone:814-838-2349
Practice Address - Fax:814-835-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000283567OtherHIGHMARK BLUE SHIELD
PA0008863300003Medicaid
PA69236OtherUNISON HEALTH PLAN
NY02731175Medicaid
PA1011839OtherGATEWAY HEALTHPLAN
OH0715891Medicaid
221020OtherHEALTH AMERICA/HEALTH ASS
PA000283567OtherHIGHMARK BCBS
NY02731175Medicaid