Organization
PREMIUM ORTHOTICS CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO NISENBAUM (PRESIDENT)
(866) 516-5064
Entity
Organization
Contact information
Practice address
1005 NE 125TH ST, NORTH MIAMI, FL 33161-5810
(866) 516-5064
Mailing address
1005 NE 125TH ST, NORTH MIAMI, FL 33161-5810
(866) 516-5064
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/14/2015
Last updated
10/13/2016
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