Provider Demographics
NPI:1871717991
Name:PRECISION ORTHOTICS & PROSTHETICS, INC
Entity type:Organization
Organization Name:PRECISION ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:212-213-6226
Mailing Address - Street 1:303 FIFTH AVENUE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6686
Mailing Address - Country:US
Mailing Address - Phone:212-213-6226
Mailing Address - Fax:212-213-6022
Practice Address - Street 1:303 FIFTH AVENUE
Practice Address - Street 2:SUITE 511
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6686
Practice Address - Country:US
Practice Address - Phone:212-213-6226
Practice Address - Fax:212-213-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00756432Medicaid
0219060001Medicare NSC