Provider Demographics
NPI:1962528679
Name:SUNRISE PROSTHETICS & ORTHOTICS, INC
Entity type:Organization
Organization Name:SUNRISE PROSTHETICS & ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:508-473-9943
Mailing Address - Street 1:10 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2831
Mailing Address - Country:US
Mailing Address - Phone:508-753-4738
Mailing Address - Fax:508-797-4390
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3250
Practice Address - Country:US
Practice Address - Phone:508-473-9943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE PROSTHETICS & ORTHOTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACPO1936OtherABC CERTIFICATION #
MA6036230001Medicare NSC