Provider Demographics
NPI:1083778229
Name:SCHUSTER'S SHOES,INC.
Entity Type:Organization
Organization Name:SCHUSTER'S SHOES,INC.
Other - Org Name:SCHUSTER'S SHOES,INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:856-767-8774
Mailing Address - Street 1:170 W WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2003
Mailing Address - Country:US
Mailing Address - Phone:856-767-8774
Mailing Address - Fax:856-767-5977
Practice Address - Street 1:170 W WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2003
Practice Address - Country:US
Practice Address - Phone:856-767-8774
Practice Address - Fax:856-767-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
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
NJ2692201Medicaid
NJ2692201Medicaid