Provider Demographics
NPI:1083879159
Name:SOLE E COMFORT AND FOOTCARE LLC
Entity Type:Organization
Organization Name:SOLE E COMFORT AND FOOTCARE LLC
Other - Org Name:SOLE E COMFORT AND FOOTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-284-8133
Mailing Address - Street 1:1045 ROUTE 70 # C-5
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-5806
Mailing Address - Country:US
Mailing Address - Phone:732-284-8133
Mailing Address - Fax:732-279-0161
Practice Address - Street 1:1045 ROUTE 70 # C-5
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-5806
Practice Address - Country:US
Practice Address - Phone:732-284-8133
Practice Address - Fax:732-279-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6239690001Medicare NSC