Provider Demographics
NPI:1225218159
Name:DIABETIC FOOTWEAR & SUPPLY, INC.
Entity Type:Organization
Organization Name:DIABETIC FOOTWEAR & SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:561-338-3838
Mailing Address - Street 1:7036 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 59
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3404
Mailing Address - Country:US
Mailing Address - Phone:561-338-3838
Mailing Address - Fax:561-338-5318
Practice Address - Street 1:7036 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 59
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3404
Practice Address - Country:US
Practice Address - Phone:561-338-3838
Practice Address - Fax:561-338-5318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0979350001Medicare NSC