| Organization Name: | ORTHOMOLD INC |
| NPI Number: | 1508951880 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SAM IAFRATE (PRESIDENT) |
| Mailing Address: | 5575 Jackson Blvd White Lake |
| State: | MI US |
| Postal Code: | 483831919 |
| Phone Number: | 2488894800 |
| Fax Number: | 2488894800 |
| NPI Enumeration Date: | 10/04/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |