Provider Demographics
NPI:1124213806
Name:LIVING COMFORT FOOTWEAR LTD
Entity Type:Organization
Organization Name:LIVING COMFORT FOOTWEAR LTD
Other - Org Name:LIVING COMFORT FOOTWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:631-321-1666
Mailing Address - Street 1:105 ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2600
Mailing Address - Country:US
Mailing Address - Phone:631-669-0721
Mailing Address - Fax:631-539-4370
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE 113
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-321-1666
Practice Address - Fax:631-587-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5033430001Medicare NSC