Provider Demographics
NPI:1033292040
Name:ALLIED ORTHOPEDIC APPLIANCES INC
Entity Type:Organization
Organization Name:ALLIED ORTHOPEDIC APPLIANCES INC
Other - Org Name:GREAT LAKES HOME HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:814-877-6121
Mailing Address - Street 1:1647 SASSAFRAS ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1858
Mailing Address - Country:US
Mailing Address - Phone:814-877-6121
Mailing Address - Fax:814-459-1858
Practice Address - Street 1:512 W 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4857
Practice Address - Country:US
Practice Address - Phone:716-664-5092
Practice Address - Fax:716-664-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57AL0000864332B00000X
332BP3500X, 335E00000X
NY025358332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011204301OtherUNIVERA
NY00610802Medicaid
NY000000076933OtherGHI
NY0551090001OtherBC/BS WNY
NY10325460OtherFIDELIS
NY8208101OtherIHA
PA1007347250005Medicaid
NY=========OtherAARP AND NOVA
PA1007347250005Medicaid