Provider Demographics
NPI:1225135205
Name:ROCHESTER ORTHOPEDIC LABORATORIES, INC.
Entity Type:Organization
Organization Name:ROCHESTER ORTHOPEDIC LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-272-1060
Mailing Address - Street 1:300 AIRPARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5723
Mailing Address - Country:US
Mailing Address - Phone:585-272-1060
Mailing Address - Fax:585-272-0871
Practice Address - Street 1:300 AIRPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5723
Practice Address - Country:US
Practice Address - Phone:585-272-1060
Practice Address - Fax:585-272-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00422808Medicaid
NYVA528-14-D-0089OtherVA
NYVA528-14-D-0089OtherVA
NY0447340002Medicare NSC
NY103306GDOtherPREFERRED CARE PROVIDER #