Organization
MODERN LIMB AND BRACE CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD J SULIMA (PRESIDENT)
(215) 455-6878
Entity
Organization
Contact information
Practice address
5310 RISING SUN AVE, PHILA, PA 19120-3031
(215) 455-6878
(215) 455-8560
Mailing address
5310 RISING SUN AVE, PHILA, PA 19120-3031
(215) 455-6878
(215) 455-8560
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002647000
BLUE CROSS
PA
Enumeration date
10/04/2006
Last updated
08/22/2020
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