Provider Demographics
NPI:1649275108
Name:ABILITY PROSTHETICS & ORTHOTICS LLC
Entity type:Organization
Organization Name:ABILITY PROSTHETICS & ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-571-8979
Mailing Address - Street 1:52 NATIONAL DR
Mailing Address - Street 2:STE 2
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1212
Mailing Address - Country:US
Mailing Address - Phone:860-571-8979
Mailing Address - Fax:860-571-8902
Practice Address - Street 1:52 NATIONAL DR
Practice Address - Street 2:STE 2
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1212
Practice Address - Country:US
Practice Address - Phone:860-571-8979
Practice Address - Fax:860-571-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00421234600OtherBLUE CARE FAMILY PLAN
CT12DME0786CT01OtherANTHEM BC/BS
CT2823492OtherAETNA HMO
CT745411OtherCONNECTICARE
CT81479OtherNORTHWOOD / NPN
CT7597384OtherAETNA NON-HMO
CT90036888OtherPMSI
CT004212346Medicaid
CT90036888OtherPMSI