1053317560 NPI number — FDR CENTER FOR PROSTHETICS & ORTHOTICS, INC.

Table of content: (NPI 1053317560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053317560 NPI number — FDR CENTER FOR PROSTHETICS & ORTHOTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FDR CENTER FOR PROSTHETICS & ORTHOTICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053317560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 SIMON STREET
Provider Second Line Business Mailing Address:
UNIT 7
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-595-9255
Provider Business Mailing Address Fax Number:
603-595-9253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 SIMON ST
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-595-9255
Provider Business Practice Location Address Fax Number:
603-595-9253
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARNEY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-595-9255

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30762338 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA393 . This is a "HARVARD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 398654 . This is a "B/C B/S MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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