Provider Demographics
NPI:1912233065
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:
Authorized Official - Last Name:RATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-370-3338
Mailing Address - Street 1:624 MCCLELLAN ST
Mailing Address - Street 2:STE G05
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1020
Mailing Address - Country:US
Mailing Address - Phone:518-370-3338
Mailing Address - Fax:518-344-1229
Practice Address - Street 1:624 MCCLELLAN ST
Practice Address - Street 2:STE G05
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-370-3338
Practice Address - Fax:518-344-1229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL DISTRICT ORHOTIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180400-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5341410001Medicare NSC