Organization
EAST SIDE ORTHORTICS AND PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP JACKSON (OFFICE MANAGER)
(347) 853-0295
Entity
Organization
Contact information
Practice address
3843 UNION RD, SUITE #15, CHEEKTOWAGA, NY 14225-4256
(347) 853-0295
Mailing address
3843 UNION RD, SUITE #15, CHEEKTOWAGA, NY 14225-4256
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/21/2013
Last updated
10/21/2013
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