Organization
EASTSIDE ORTHOTICS & PROSTHETICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW D FLYNN CP (PRESIDENT)
(631) 727-8735
Entity
Organization
Contact information
Practice address
889 HARRISON AVE, SUITE 2A, RIVERHEAD, NY 11901-2090
(631) 727-8735
(631) 727-6834
Mailing address
889 HARRISON AVE, SUITE 2A, RIVERHEAD, NY 11901-2090
(631) 727-8735
(631) 727-6834
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02247905
—
NY
Enumeration date
07/05/2005
Last updated
09/14/2015
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