Provider Demographics
NPI:1255668737
Name:ORTHO SHOES CORP
Entity Type:Organization
Organization Name:ORTHO SHOES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIYEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADZHIASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:917-304-6657
Mailing Address - Street 1:10032 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2748
Mailing Address - Country:US
Mailing Address - Phone:917-304-6657
Mailing Address - Fax:
Practice Address - Street 1:10032 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2748
Practice Address - Country:US
Practice Address - Phone:917-304-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPED 3003332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6382980001Medicare NSC