Provider Demographics
NPI:1073580759
Name:ADVANCED ORTHOTICS & PROSTHETICS , LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOTICS & PROSTHETICS , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:518-279-4422
Mailing Address - Street 1:950 HOOSICK RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6635
Mailing Address - Country:US
Mailing Address - Phone:518-279-4422
Mailing Address - Fax:518-279-0033
Practice Address - Street 1:950 HOOSICK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6635
Practice Address - Country:US
Practice Address - Phone:518-279-4422
Practice Address - Fax:518-279-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52371OtherGHI HMO
NYG72541OtherEMPIRE BC/BS
NY600337OtherMVP
NY00040246000OtherBLUE SHIELD NENY
NY10052506OtherCDPHP
NM7104270OtherAETNA
NYG72541OtherEMPIRE BC/BS