Provider Demographics
NPI:1548655814
Name:ABILITY ORTHOTICS & PROSTHETICS LAB LLC
Entity type:Organization
Organization Name:ABILITY ORTHOTICS & PROSTHETICS LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MULVANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-497-8007
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-0365
Mailing Address - Country:US
Mailing Address - Phone:518-319-4199
Mailing Address - Fax:518-319-4197
Practice Address - Street 1:566 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2034
Practice Address - Country:US
Practice Address - Phone:518-319-4199
Practice Address - Fax:518-319-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier