Provider Demographics
NPI:1730601527
Name:NORTH SHORE PROSTHETICS AND ORTHOTICS INC.
Entity type:Organization
Organization Name:NORTH SHORE PROSTHETICS AND ORTHOTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-371-2593
Mailing Address - Street 1:719 KAMEHAMEHA HWY STE B100
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2771
Mailing Address - Country:US
Mailing Address - Phone:808-744-5642
Mailing Address - Fax:808-892-1456
Practice Address - Street 1:425 KAMEHAMEHA HWY STE 101
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3238
Practice Address - Country:US
Practice Address - Phone:808-744-5642
Practice Address - Fax:808-892-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier