Provider Demographics
NPI:1235596776
Name:MS FOOTSTOP INC.
Entity Type:Organization
Organization Name:MS FOOTSTOP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-944-2391
Mailing Address - Street 1:1475 BERGEN BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2164
Mailing Address - Country:US
Mailing Address - Phone:201-944-2391
Mailing Address - Fax:
Practice Address - Street 1:1475 BERGEN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2164
Practice Address - Country:US
Practice Address - Phone:201-944-2391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies