Provider Demographics
NPI:1093999039
Name:HAVE SHOES WILL TRAVEL LLC
Entity Type:Organization
Organization Name:HAVE SHOES WILL TRAVEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-366-4101
Mailing Address - Street 1:724 ANDERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2172
Mailing Address - Country:US
Mailing Address - Phone:201-366-4101
Mailing Address - Fax:201-917-3645
Practice Address - Street 1:724 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2029
Practice Address - Country:US
Practice Address - Phone:201-366-4101
Practice Address - Fax:201-917-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0016489Medicaid
NJ4697320001Medicare NSC