MR. JAN PEDERSEN BOCO ORTHOTIST NPI 1386866234

NPI Information

NPI: 1386866234
Provider Name: MR. JAN PEDERSEN, BOCO ORTHOTIST
Classification: Prosthetic/Orthotic Supplier - 335E00000X
Entity Type: Individual
Address:
23 ALGONQUIN RD
WEST SAND LAKE, NY
ZIP 12196
Phone: (518) 674-3361
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MR. Jan Pedersen, BOCO ORTHOTIST is a prosthetic orthotic supplier in West Sand Lake, NY. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. MR. Jan Pedersen, BOCO ORTHOTIST NPI is 1386866234. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

23 ALGONQUIN RD
WEST SAND LAKE, NY
ZIP 12196-000
Phone: (518) 674-3361
Fax: (518) 674-8320

The enumeration date for this NPI number is 5/2/2007 and was last updated on 4/24/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	335E00000X	Prosthetic/Orthotic Supplier				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01755577	MEDICAID	NEW YORK
2	4483480001	MEDICARE NSC	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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