Provider Demographics
NPI:1871732826
Name:NEW YORK ORTHOTIC & PROSTHETIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:NEW YORK ORTHOTIC & PROSTHETIC ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:516-216-1888
Mailing Address - Street 1:810 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4514
Mailing Address - Country:US
Mailing Address - Phone:516-216-1888
Mailing Address - Fax:516-233-1889
Practice Address - Street 1:810 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4514
Practice Address - Country:US
Practice Address - Phone:516-216-1888
Practice Address - Fax:516-233-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier