NPIMap

Organization Active NPI

Eastside Orthotics & Prosthetics Inc

  • Prosthetic/Orthotic Supplier
  • Stamford, CT
National Provider Identifier
1093719593
Registry record updated Jun 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
EASTSIDE ORTHOTICS & PROSTHETICS INC
Practice address
26 Palmers Hill Rd
RM 1000
Stamford, CT 06902-2113
Phone
(203) 975-9004
Fax
(203) 975-9008
NPI assigned
Jun 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Matthew D Flynn, CP
Title
President
Phone
(631) 727-8735

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

26 Palmers Hill Rd
RM 1000
Stamford, CT 06902-2113

Mailing address

34 Commerce Dr
Ste 200
Riverhead, NY 11901-3118
Phone (631) 727-8735

Other identifiers 1

IdentifierTypeStateIssuer
004240652MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
Eastside Orthotics Prosthetics Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

26 Palmers HL Rd
RM 1000
Stamford, CT 06902
Phone (203) 975-9004

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1093719593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 COMMERCE DR",
            "address_2": "STE 200",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119013118",
            "telephone_number": "631-727-8735",
            "fax_number": "631-727-6834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 PALMERS HILL RD",
            "address_2": "RM 1000",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069022113",
            "telephone_number": "203-975-9004",
            "fax_number": "203-975-9008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE ORTHOTICS & PROSTHETICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "FLYNN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-727-8735",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004240652",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.