Organization
GREEN PROSTHETICS & ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAKESH JAIN (CEO)
(201) 774-1085
Entity
Organization
Contact information
Practice address
2241 PENINSULA DR, ERIE, PA 16506-2954
(814) 833-2311
(814) 833-5202
Mailing address
2241 PENINSULA DR, ERIE, PA 16506-2954
(814) 833-2311
(814) 833-5202
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
6000005987
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02254635
NY
NY
01
—
0322029
OH
OH
05
—
1007721900001
—
PA
Enumeration date
08/24/2005
Last updated
04/26/2024
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