Provider Demographics
NPI:1548357759
Name:ORTHO CARE, INC
Entity type:Organization
Organization Name:ORTHO CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:MOOERS
Authorized Official - Last Name:DIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, BOCPO, CPED
Authorized Official - Phone:908-232-9910
Mailing Address - Street 1:10 PROSPECT ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2114
Mailing Address - Country:US
Mailing Address - Phone:908-232-9910
Mailing Address - Fax:908-232-9915
Practice Address - Street 1:10 PROSPECT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2114
Practice Address - Country:US
Practice Address - Phone:908-232-9910
Practice Address - Fax:908-232-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NJ45PO00014100335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0244376Medicaid
NJ=========OtherHORIZON PROVIDER NUMBER
NJ1101610001Medicare NSC