Provider Demographics
NPI:1699865147
Name:ORTHOTICS & PROSTHETICS TECHNOLOGIES CORP
Entity type:Organization
Organization Name:ORTHOTICS & PROSTHETICS TECHNOLOGIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST & PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CPO
Authorized Official - Phone:845-358-4747
Mailing Address - Street 1:2 AURA DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1208
Mailing Address - Country:US
Mailing Address - Phone:845-358-4747
Mailing Address - Fax:
Practice Address - Street 1:2 AURA DR
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1208
Practice Address - Country:US
Practice Address - Phone:845-358-1956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00004500335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYANC1592OtherOXFORD INS. PROVIDER #
NY1697990001Medicare NSC