Provider Demographics
NPI:1972782324
Name:ADVANCED ORTHOTICS & PROSTHETICS LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOTICS & PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-472-1023
Mailing Address - Street 1:350 NORTHERN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1000
Mailing Address - Country:US
Mailing Address - Phone:518-472-1023
Mailing Address - Fax:518-472-1024
Practice Address - Street 1:350 NORTHERN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1000
Practice Address - Country:US
Practice Address - Phone:518-472-1023
Practice Address - Fax:518-472-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3873180003Medicare NSC