Provider Demographics
NPI:1316936354
Name:HOWARD, ROGER R (CPO)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:R
Last Name:HOWARD
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3614
Mailing Address - Country:US
Mailing Address - Phone:315-786-8973
Mailing Address - Fax:315-786-7993
Practice Address - Street 1:316 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3614
Practice Address - Country:US
Practice Address - Phone:315-786-8973
Practice Address - Fax:315-786-7993
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02386432Medicaid
NY02386432Medicaid
4697030001Medicare NSC