Individual
MR. BETHANAPALLI BOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
6911 FORT HAMILTON PKWY, BROOKLYN, NY 11228-1101
(718) 680-0225
(201) 796-5414
Mailing address
1-25 26TH ST, FAIR LAWN, NJ 07410-3802
(718) 680-0225
(201) 796-5414
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
1127940
NY
224P00000X
Prosthetist
1127940
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00835727
—
NY
Enumeration date
11/15/2006
Last updated
02/01/2008
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