Individual
MR. JAN PEDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BOCO ORTHOTIST
Contact information
Practice address
23 ALGONQUIN RD, WEST SAND LAKE, NY 12196-2000
(518) 674-3361
(518) 674-8320
Mailing address
23 ALGONQUIN RD, WEST SAND LAKE, NY 12196-2000
(518) 674-3361
(518) 674-8320
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01755577
—
NY
Enumeration date
05/02/2007
Last updated
04/24/2008
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