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General NPI Number Information
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NPI Number | 1154964955
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Entity Type | Organization
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Legal Business Name | NORTHERN ORTHOPEDIC LABORATORY INC.
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 6604 STATE HIGHWAY 56 APT 6
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City | POTSDAM
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State | NY
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Zip | 13676-3546
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Country | US
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Telephone | 315-782-9079
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 WASHINGTON ST
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City | WATERTOWN
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State | NY
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Zip | 13601-4337
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Country | US
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Telephone | 315-782-9079
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD W HOLMES
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Credential | CPO
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Telephone | 315-782-9079
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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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