Provider Demographics
NPI:1083880900
Name:ADVANCED PROSTHETIC DESIGN LLC
Entity Type:Organization
Organization Name:ADVANCED PROSTHETIC DESIGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:COLES
Authorized Official - Last Name:GUBLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-663-5860
Mailing Address - Street 1:42 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4729
Mailing Address - Country:US
Mailing Address - Phone:585-663-5860
Mailing Address - Fax:585-663-5860
Practice Address - Street 1:1401 STONE RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1537
Practice Address - Country:US
Practice Address - Phone:585-663-5860
Practice Address - Fax:585-663-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCPO01744335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6142190001Medicare NSC