Provider Demographics
NPI:1275612145
Name:OLYMPIC ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:OLYMPIC ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-842-2003
Mailing Address - Street 1:652 SUFFOLK AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4305
Mailing Address - Country:US
Mailing Address - Phone:631-617-5181
Mailing Address - Fax:631-617-5182
Practice Address - Street 1:652 SUFFOLK AVE STE 210
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4305
Practice Address - Country:US
Practice Address - Phone:631-617-5181
Practice Address - Fax:631-617-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166030207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWR361Medicare PIN