Jan Pedersen

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

JAN PEDERSEN

Practice address

23 Algonquin Rd
West Sand Lake, NY 12196-2000

Phone

(518) 674-3361

Fax

(518) 674-8320

NPI assigned

Nov 15, 2007

Last updated

Nov 15, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jan Pedersen, ORTHOTISTNPI 1386866234

Title

Owner

Phone

(518) 674-3361

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jan Pedersen, BOCO ORTHOTIST

  • Prosthetic/Orthotic Supplier
  • West Sand Lake, NY
  • NPI 1386866234
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1104007442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 ALGONQUIN RD",
            "city": "WEST SAND LAKE",
            "state": "NY",
            "postal_code": "121962000",
            "telephone_number": "518-674-3361",
            "fax_number": "518-674-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 ALGONQUIN RD",
            "city": "WEST SAND LAKE",
            "state": "NY",
            "postal_code": "121962000",
            "telephone_number": "518-674-3361",
            "fax_number": "518-674-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAN PEDERSEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-674-3361",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ORTHOTIST"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01755577",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacquelynn Elliott, LMT
• Kristin Jill Esposita-Ublacker
• Damian F Fleming, PHARM D
• Kelly Halpin
• Jeffrey Jacobsen
• Christa Grace Kearsey
• Linda Lombardi
• Christina Malone, M.S., C.C.C.
• Martins Foods of South Burlington LLC (Hannaford Supermarket & Pharmacy)
• Shannon McCormick, PHARMD

• Prosthetic/Orthotic Supplier in West Sand Lake, NY
• Providers in West Sand Lake, NY by specialty
• Prosthetic/Orthotic Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.