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General NPI Number Information
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NPI Number | 1093876278
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Entity Type | Organization
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Legal Business Name | PANKOW ORTHOTICS & PROSTHETICS, LLC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 5489 BROADWAY ST
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City | LANCASTER
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State | NY
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Zip | 14086-2219
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Country | US
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Telephone | 716-651-0660
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Fax | 716-651-0668
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Provider Business Mailing Address
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Address Line | 5489 BROADWAY
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City | LANCASTER
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State | NY
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Zip | 14086
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Country | US
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Telephone | 716-651-0660
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Fax | 716-651-0668
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES E. PANKOW
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Credential | BS,CPO
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Telephone | 716-651-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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