Provider Demographics
NPI:1093848244
Name:SOLUP SHOE INC
Entity Type:Organization
Organization Name:SOLUP SHOE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:SOLUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-324-4500
Mailing Address - Street 1:130 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4802
Mailing Address - Country:US
Mailing Address - Phone:781-324-4500
Mailing Address - Fax:
Practice Address - Street 1:130 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4802
Practice Address - Country:US
Practice Address - Phone:781-324-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1359920001Medicare NSC