Organization
GREAT SOUTH BAY BRACING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNAMARIE OTTO (OWNER)
(631) 714-4770
Entity
Organization
Contact information
Practice address
32 WALNUT AVE, PATCHOGUE, NY 11772-2621
(631) 714-4770
Mailing address
32 WALNUT AVE, PATCHOGUE, NY 11772-2621
(631) 714-4770
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/07/2011
Last updated
07/07/2011
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