Provider Demographics
NPI:1043326010
Name:YALE COMFORT SHOE CENTER LLC
Entity Type:Organization
Organization Name:YALE COMFORT SHOE CENTER LLC
Other - Org Name:YALE COMFORT SHOE-YALE SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-777-2396
Mailing Address - Street 1:627 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6992
Mailing Address - Country:US
Mailing Address - Phone:203-777-2396
Mailing Address - Fax:203-777-4617
Practice Address - Street 1:305 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5246
Practice Address - Country:US
Practice Address - Phone:203-372-7112
Practice Address - Fax:203-338-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12DME0905CT01OtherBCBS
CTOV6079OtherHEALTHNET
CT004096295Medicaid
CT12DME0905CT01OtherBCBS