Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
Eastside Orthotics & Prosthetics
Provider ID
P000005825
NPI
1851395388
Tax ID
113154194
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
417 East 72nd St Suite 1B
New York, NY 10021
United States
County
New York
Phone
2154971001 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address