Provider Demographics
NPI:1154502474
Name:RAM ORTHOTIC & PROSTHETIC LAB, LLC
Entity Type:Organization
Organization Name:RAM ORTHOTIC & PROSTHETIC LAB, LLC
Other - Org Name:RAMPERSAUD MADHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMPERSAUD
Authorized Official - Middle Name:
Authorized Official - Last Name:MADHO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:518-377-6080
Mailing Address - Street 1:2142 ROSA RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3708
Mailing Address - Country:US
Mailing Address - Phone:518-377-6080
Mailing Address - Fax:518-377-9490
Practice Address - Street 1:2142 ROSA RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-3708
Practice Address - Country:US
Practice Address - Phone:518-377-6080
Practice Address - Fax:518-377-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000402684006OtherBLUESHIELD OF NORTHEASTERN NY
NY793286OtherMVP
NY120330000044OtherFIDELIS
NY9257823OtherAETNA
PA102692393 0001OtherPA ACCESS
NY110060845003OtherCDPHP
NY02376245Medicaid
NY02376245Medicaid
NY9257823OtherAETNA