Organization
EASTERN PEDORTHICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES STOUT CPED (OWNER)
(609) 737-7701
Entity
Organization
Contact information
Practice address
7 ROUTE 31 N, PENNINGTON, NJ 08534-1612
(609) 737-7701
(609) 737-7705
Mailing address
7 ROUTE 31 N, PENNINGTON, NJ 08534-1612
(609) 737-7701
(609) 737-7705
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6757502
—
NJ
01
—
823763
AETNA PROVIDER NUMBER
NJ
Enumeration date
01/29/2007
Last updated
07/22/2009
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