1841333895 NPI number — ORTHOTICS PARTNERS PLUS

Table of content: (NPI 1841333895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841333895 NPI number — ORTHOTICS PARTNERS PLUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOTICS PARTNERS PLUS
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:
1841333895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 S BAY RD
Provider Second Line Business Mailing Address:
ATTN BRIDGET
Provider Business Mailing Address City Name:
NORTH SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13212-3627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-458-1777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110- 114 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 1 A
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-756-8831
Provider Business Practice Location Address Fax Number:
607-756-8888
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDELMAN
Authorized Official First Name:
FREDDIE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
315-458-1777

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  002777 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02119886 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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