Provider Demographics
NPI:1760606610
Name:ADVANCED ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER - OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:518-786-0687
Mailing Address - Street 1:9A HERBERT DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3801
Mailing Address - Country:US
Mailing Address - Phone:518-786-0687
Mailing Address - Fax:518-786-0687
Practice Address - Street 1:9A HERBERT DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3801
Practice Address - Country:US
Practice Address - Phone:518-786-0687
Practice Address - Fax:518-786-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier