Organization
GREAT LAKES ORTHOPEDIC LABS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS J DALEY CPO (VICE PRESIDENT)
(716) 893-4116
Entity
Organization
Contact information
Practice address
1031 MAIN ST, BUFFALO, NY 14203-1014
(716) 893-4116
(716) 897-2110
Mailing address
1031 MAIN ST, BUFFALO, NY 14203-1014
(716) 893-4116
(716) 897-2110
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011212601
UNIVERA HEALTHCARE
NY
01
—
000551033001
BLUE CROSS & BLUE SHIELD
NY
01
—
040401000151
FIDELIS CARE NEW YORK
NY
01
—
16146
MOLINA HEALTHCARE
NY
01
—
8207649
INDEPENDENT HEALTH ASSOCI
NY
Enumeration date
11/01/2006
Last updated
12/29/2023
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