Provider Demographics
NPI:1003978701
Name:CERNY SHOES, INC.
Entity Type:Organization
Organization Name:CERNY SHOES, INC.
Other - Org Name:CERNY SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-226-4361
Mailing Address - Street 1:15002 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3914
Mailing Address - Country:US
Mailing Address - Phone:216-226-4361
Mailing Address - Fax:216-226-4458
Practice Address - Street 1:15002 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3914
Practice Address - Country:US
Practice Address - Phone:216-226-4361
Practice Address - Fax:216-226-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18491238332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211805Medicaid
OH2211805Medicaid