Provider Demographics
NPI:1699757534
Name:GRIFFIN ORTHOPEDIC TECHNOLOGIES INC
Entity type:Organization
Organization Name:GRIFFIN ORTHOPEDIC TECHNOLOGIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:781-837-2294
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:GREEN HARBOR
Mailing Address - State:MA
Mailing Address - Zip Code:02041-0386
Mailing Address - Country:US
Mailing Address - Phone:781-837-2294
Mailing Address - Fax:781-837-2294
Practice Address - Street 1:696 MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2018
Practice Address - Country:US
Practice Address - Phone:781-837-2294
Practice Address - Fax:781-837-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPO02429335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA377754OtherBCBS MA
MA1537075Medicaid
MA1537075Medicaid