Provider Demographics
NPI:1437338522
Name:CONCORD PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:CONCORD PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRIGORIEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-371-1684
Mailing Address - Street 1:801 MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3313
Mailing Address - Country:US
Mailing Address - Phone:978-371-1684
Mailing Address - Fax:978-371-7504
Practice Address - Street 1:801 MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3313
Practice Address - Country:US
Practice Address - Phone:978-371-1684
Practice Address - Fax:978-371-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1531484Medicaid
MA96949701OtherNETWORK HEALTH
NH30003020Medicaid
MA711116OtherTUFTS
MA6340OtherFALLON
MA700626OtherHARVARD PILGRIM
ME151560000Medicaid
MA277754OtherBLUE CROSS BLUE SHIELD
ME151560000Medicaid