Provider Demographics
NPI:1295848273
Name:ORTHOPEDIC ASSOCIATES OF 65 PENNA AVENUE, PC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF 65 PENNA AVENUE, PC
Other - Org Name:ORTHOPEDIC ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-723-5393
Mailing Address - Street 1:65 PENNSYLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-9999
Mailing Address - Country:US
Mailing Address - Phone:607-723-5393
Mailing Address - Fax:607-771-0803
Practice Address - Street 1:65 PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-9999
Practice Address - Country:US
Practice Address - Phone:607-723-5393
Practice Address - Fax:607-771-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00979680Medicaid
NY34739AMedicare UPIN
NY0420900001Medicare NSC