Provider Demographics
NPI:1043291586
Name:SHOE STUDIO, LLC
Entity Type:Organization
Organization Name:SHOE STUDIO, LLC
Other - Org Name:FIRST AID MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARKADY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTSKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-318-6586
Mailing Address - Street 1:6999 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1430
Mailing Address - Country:US
Mailing Address - Phone:410-318-6586
Mailing Address - Fax:410-318-6620
Practice Address - Street 1:6999 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1430
Practice Address - Country:US
Practice Address - Phone:410-318-6586
Practice Address - Fax:410-318-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4463490001Medicare ID - Type Unspecified