Provider Demographics
NPI:1518077239
Name:FDR CENTER FOR PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:FDR CENTER FOR PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:NORTHEASTERN PROSTHETIC & BRACE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-595-9255
Mailing Address - Street 1:8 RAY AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4721
Mailing Address - Country:US
Mailing Address - Phone:781-273-5462
Mailing Address - Fax:781-273-5468
Practice Address - Street 1:8 RAY AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4721
Practice Address - Country:US
Practice Address - Phone:781-273-5462
Practice Address - Fax:781-273-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1511068Medicaid
MA398654OtherBC/BS MA
MA661968OtherTUFTS
MA398654OtherBC/BS MA