Organization
EASTSIDE ORTHOTICS & PROSTHETICS INC
Active
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
417 E 72ND ST, NEW YORK, NY 10021-4414
(212) 326-8501
(212) 326-8538
Mailing address
889 HARRISON AVE, STE 2A, RIVERHEAD, NY 11901-2090
(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
—
02247890
—
NY
Enumeration date
06/13/2005
Last updated
08/12/2013
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