Organization
PROTHOTIC LABORATORY, INC.
Active
Organization
PROTHOTIC LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J QUIGG CPO (CEO)
(631) 753-4444
Entity
Organization
Contact information
Practice address
2023 NEW HWY, FARMINGDALE, NY 11735-1103
(631) 753-4444
(631) 753-4451
Mailing address
2023 NEW HWY, FARMINGDALE, NY 11735-1103
(631) 753-4444
(631) 753-4451
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000574766
UNITED HEALTHCARE
—
05
—
01126865
—
NY
01
—
040810000002
FIDELIS CARE
—
01
—
1000002465
AFFINITY HEALTH PLAN
—
01
—
3CO793
HEALTH NET (PHS
—
01
—
45797
AETNA HMO
—
01
—
57C0391
COMMUNITY PREMIER PLUS
—
01
—
8450582
AETNA NON-HMO
—
01
—
A2559046
OXFORD HEALTH PLAN
—
01
—
A32A0031
ABC HEALTH PLAN
—
01
—
ANC0027-01
AMERICHOICE
—
01
—
G54141
EMPIRE HEALTH CHOICE
—
Enumeration date
08/09/2005
Last updated
09/18/2024
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