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General NPI Number Information
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NPI Number | 1245318278
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Entity Type | Organization
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Legal Business Name | GREAT LAKES ORTHOPEDIC LABS, INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 1031 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14203-1014
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Country | US
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Telephone | 716-893-4116
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Fax | 716-897-2110
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Provider Business Mailing Address
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Address Line | 1031 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14203-1014
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Country | US
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Telephone | 716-893-4116
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Fax | 716-897-2110
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. THOMAS J DALEY
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Credential | CPO
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Telephone | 716-893-4116
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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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