Provider Demographics
NPI:1982736914
Name:CAD-CAM ORTHOTICS INC.
Entity Type:Organization
Organization Name:CAD-CAM ORTHOTICS INC.
Other - Org Name:MADISON AVENUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:607-733-6541
Mailing Address - Street 1:200 MADISON AVE
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3218
Mailing Address - Country:US
Mailing Address - Phone:607-733-9209
Mailing Address - Fax:607-733-9368
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:SUITE 1G
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3218
Practice Address - Country:US
Practice Address - Phone:607-733-9209
Practice Address - Fax:607-733-9368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH'S HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024476332B00000X, 333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995380Medicaid
3308106OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC1290240001Medicare NSC