Provider Demographics
NPI:1972754380
Name:CAPITAL DISTRICT ORTHOTIC GROUP
Entity Type:Organization
Organization Name:CAPITAL DISTRICT ORTHOTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-370-3338
Mailing Address - Street 1:2341 NOTT ST E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4332
Mailing Address - Country:US
Mailing Address - Phone:518-370-3338
Mailing Address - Fax:518-344-1229
Practice Address - Street 1:1540 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5052
Practice Address - Country:US
Practice Address - Phone:518-608-6852
Practice Address - Fax:518-344-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180400-1208D00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty