Provider Demographics
NPI:1720568546
Name:SCIENTIFIC SPINE & ORTHOPEDIC DEVICES LLC
Entity Type:Organization
Organization Name:SCIENTIFIC SPINE & ORTHOPEDIC DEVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CAPICOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-881-0382
Mailing Address - Street 1:SCIENTIFIC SPINE & ORTHOPEDIC DEVICES LLC
Mailing Address - Street 2:6580 MAIN STREET, SUITE 2
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-881-0382
Mailing Address - Fax:
Practice Address - Street 1:SCIENTIFIC SPINE & ORTHOPEDIC DEVICES LLC
Practice Address - Street 2:6580 MAIN STREET, SUITE 2
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-881-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1356484174OtherNPPES