Healthcare Provider Details

I. General information

NPI: 1992718712
Provider Name (Legal Business Name): EDWARD FAIRCHILD CO, CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 STATE ST COLONIAL PLAZA
BINGHAMTON NY
13901
US

IV. Provider business mailing address

477 STATE ST COLONIAL PLAZA
BINGHAMTON NY
13901
US

V. Phone/Fax

Practice location:
  • Phone: 607-348-0343
  • Fax: 607-348-0347
Mailing address:
  • Phone: 607-348-0343
  • Fax: 607-348-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCO003702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: