Organization
EASTSIDE ORTHOTICS AND 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
622 W 168TH ST, VC333, NEW YORK, NY 10032
(212) 305-3275
(212) 305-5927
Mailing address
34 COMMERCE DR, SUITE 200, RIVERHEAD, NY 11901-3174
(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
—
01052611
—
NY
Enumeration date
06/13/2005
Last updated
09/19/2007
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