Northern Orthopedic Laboratory, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

NORTHERN ORTHOPEDIC LABORATORY, INC.

Practice address

59 Main St
Suite 300
Potsdam, NY 13676-2148

Phone

(315) 265-1673

Fax

(315) 265-1675

NPI assigned

Feb 5, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Donald W Holmes, CPO

Title

President

Phone

(315) 782-9079

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356480537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 MAIN ST",
            "address_2": "SUITE 300",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136762148",
            "telephone_number": "315-265-1673",
            "fax_number": "315-265-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 MAIN ST",
            "address_2": "SUITE 300",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136762148",
            "telephone_number": "315-265-1673",
            "fax_number": "315-265-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ORTHOPEDIC LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-782-9079",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02073449",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sara Anne O'Brian Polniak, LMHC, NCC
• Paul C O'Donnell, O.D.
• Zachary O'Neill
• Kathleen Olsen, RN

• Prosthetic/Orthotic Supplier in Potsdam, NY
• Providers in Potsdam, 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 Aug 22, 2020; 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.