Provider Demographics
NPI:1376686972
Name:THE COBBLER SHOP
Entity Type:Organization
Organization Name:THE COBBLER SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCHALE
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:609-267-6766
Mailing Address - Street 1:101 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1401
Mailing Address - Country:US
Mailing Address - Phone:609-267-6766
Mailing Address - Fax:609-518-2087
Practice Address - Street 1:101 HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1401
Practice Address - Country:US
Practice Address - Phone:609-267-6766
Practice Address - Fax:609-518-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9592332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3389390OtherDME
NJ0029041Medicaid
NJ3389390OtherDME