1942293253 NPI number — DYNAMIC ORTHOPEDIC LABORATORY

Table of content: (NPI 1942293253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942293253 NPI number — DYNAMIC ORTHOPEDIC LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC ORTHOPEDIC LABORATORY
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:
6
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:
1942293253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 ROUTE 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-2333
Provider Business Mailing Address Fax Number:
518-828-1350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 ROUTE 66
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-3429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-2333
Provider Business Practice Location Address Fax Number:
518-828-1350
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFERT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
518-828-2333

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: 00867670 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000400980001 . This is a "BSOF NORTHWEST NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10014666 . This is a "CAP. DIST. PHY. HEALTH PL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com