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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
388 WESTCHESTER AVE, STE 1J, PORT CHESTER, NY 10573-3623
(914) 935-1185
(914) 935-1187
Mailing address
34 COMMERCE DR, STE 200, RIVERHEAD, NY 11901-3118
(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
003104578
CT
05
02247914
NY
Enumeration date
06/13/2005
Last updated
06/05/2008
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