Joseph Kenneth Fairley III, CP

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

CP004468

Practice address

480 Broadway Ste LL14
Saratoga Springs, NY 12866-6727

Phone

(518) 430-2034

NPI assigned

Jan 23, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1689389785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 BROADWAY STE LL14",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "128666727",
            "telephone_number": "518-430-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 BROADWAY STE LL14",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "128666727",
            "telephone_number": "518-430-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRLEY",
        "first_name": "JOSEPH",
        "middle_name": "KENNETH",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "CP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": "CP004468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Saratoga Springs, NY
• Providers in Saratoga Springs, 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 Jan 23, 2023; 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.