Provider Demographics
NPI:1790862449
Name:LEWISTON ORTHOPEDICS PC
Entity Type:Organization
Organization Name:LEWISTON ORTHOPEDICS PC
Other - Org Name:CENTER FOR ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOPPERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-297-1701
Mailing Address - Street 1:5320 MILITARY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-297-1701
Mailing Address - Fax:716-297-1479
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-297-1701
Practice Address - Fax:716-297-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000551514001OtherBLUE CROSS DME
NY528803001OtherBLUE CROSS OF WNY
NY0903962OtherINDEPENDENT HEALTH
1790862449OtherGROUP NPI
NY00010290601OtherUNIVERA HEALTHCARE
NY0903962OtherINDEPENDENT HEALTH
B88031Medicare PIN
NYB33564Medicare UPIN
1790862449OtherGROUP NPI
NYCM4840Medicare PIN
NY0454390001Medicare NSC
A88031Medicare PIN