Provider Demographics
NPI:1083728653
Name:NATIONAL PEDORTHIC SERVICES, INC.
Entity Type:Organization
Organization Name:NATIONAL PEDORTHIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE FACILITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-438-1211
Mailing Address - Street 1:7283 W APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1932
Mailing Address - Country:US
Mailing Address - Phone:414-438-1211
Mailing Address - Fax:414-438-1051
Practice Address - Street 1:1280 SCOTTSVILLE RD
Practice Address - Street 2:SUITE 20
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5147
Practice Address - Country:US
Practice Address - Phone:585-235-9030
Practice Address - Fax:585-235-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01753346Medicaid
NY01753346Medicaid