Organization
JAG ORTHOTICS & PROSTHETICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRIGORIY KANDKHOROV (PRESIDENT)
(917) 863-4969
Entity
Organization
Contact information
Practice address
8408 37TH AVE, JACKSON HEIGHTS, NY 11372-7339
(718) 665-3706
(718) 865-5129
Mailing address
8408 37TH AVE, JACKSON HEIGHTS, NY 11372-7339
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6800710001
MEDICARE PTAN
NY
Enumeration date
03/05/2013
Last updated
09/11/2024
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