Healthcare Provider Details

I. General information

NPI: 1003544677
Provider Name (Legal Business Name): CLINICAL PROSTHETICS & ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MAIN ST
QUEENSBURY NY
12804-4007
US

IV. Provider business mailing address

17 MAIN ST
QUEENSBURY NY
12804-4007
US

V. Phone/Fax

Practice location:
  • Phone: 518-828-1698
  • Fax: 518-380-2393
Mailing address:
  • Phone: 518-828-1698
  • Fax: 518-380-2393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TERESA ANN SANDERCOX
Title or Position: BUSINESS ADMINISTRATIVE MANAGER
Credential:
Phone: 315-538-3033