Provider Demographics
NPI:1255517785
Name:EMPIRE STATE PROSTHETICS, INC.
Entity type:Organization
Organization Name:EMPIRE STATE PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAUT
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:516-378-0975
Mailing Address - Street 1:164B LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1512
Mailing Address - Country:US
Mailing Address - Phone:516-378-0975
Mailing Address - Fax:
Practice Address - Street 1:164B LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1512
Practice Address - Country:US
Practice Address - Phone:516-378-0975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02915415Medicaid
NY5771640001Medicare NSC