Provider Demographics
NPI:1538228440
Name:ORTHOPEDIC APPLIANCES OF CENTRAL NEW YORK, INC.
Entity type:Organization
Organization Name:ORTHOPEDIC APPLIANCES OF CENTRAL NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:HETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:315-474-2464
Mailing Address - Street 1:507 EAST FAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1951
Mailing Address - Country:US
Mailing Address - Phone:315-474-2464
Mailing Address - Fax:315-474-2465
Practice Address - Street 1:507 EAST FAYETTE STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1951
Practice Address - Country:US
Practice Address - Phone:315-474-2464
Practice Address - Fax:315-474-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00569746Medicaid
NY00569746Medicaid