Provider Demographics
NPI:1902105505
Name:BRAY ORTHOTICS AND PROSTHETICS LLC
Entity Type:Organization
Organization Name:BRAY ORTHOTICS AND PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO,CPED
Authorized Official - Phone:201-666-6647
Mailing Address - Street 1:217 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3130
Mailing Address - Country:US
Mailing Address - Phone:201-666-6647
Mailing Address - Fax:201-666-5551
Practice Address - Street 1:217 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3130
Practice Address - Country:US
Practice Address - Phone:201-666-6647
Practice Address - Fax:201-666-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45P000014900335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier