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Organization
DIVERSIFIED ORTHOTICS
Active
Organization
DIVERSIFIED ORTHOTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS ALFRED ROSE DO (ORTHOTIST)
(718) 409-6280
Entity
Organization
Contact information
Practice address
3146 E TREMONT AVE, BRONX, NY 10461-5706
(718) 409-6280
(718) 409-4110
Mailing address
3146 E TREMONT AVE, BRONX, NY 10461-5706
(718) 409-6280
(718) 409-4110
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01488857
—
NY
01
—
0870060001
MEDICARE
NY
Enumeration date
04/16/2008
Last updated
10/07/2021
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