Provider Demographics
NPI:1235906611
Name:TWISTED LACES LLC
Entity Type:Organization
Organization Name:TWISTED LACES LLC
Other - Org Name:SCHUSTERS DIABETIC SHOES & MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-809-2930
Mailing Address - Street 1:95 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2321
Mailing Address - Country:US
Mailing Address - Phone:856-809-2930
Mailing Address - Fax:
Practice Address - Street 1:95 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2321
Practice Address - Country:US
Practice Address - Phone:856-809-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty