Provider Demographics
NPI:1841333895
Name:ORTHOTICS PARTNERS PLUS
Entity type:Organization
Organization Name:ORTHOTICS PARTNERS PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-458-1777
Mailing Address - Street 1:514 S BAY RD
Mailing Address - Street 2:ATTN BRIDGET
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3627
Mailing Address - Country:US
Mailing Address - Phone:315-458-1777
Mailing Address - Fax:
Practice Address - Street 1:110- 114 NORTH MAIN STREET
Practice Address - Street 2:SUITE 1 A
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1250
Practice Address - Country:US
Practice Address - Phone:607-756-8831
Practice Address - Fax:607-756-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002777335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02119886Medicaid
1299960001Medicare ID - Type Unspecified