Provider Demographics
NPI:1518007913
Name:SURGICAL SOCK SHOP, INC.
Entity Type:Organization
Organization Name:SURGICAL SOCK SHOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-425-2617
Mailing Address - Street 1:1 JOSHUA CT
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3640
Mailing Address - Country:US
Mailing Address - Phone:845-425-2617
Mailing Address - Fax:845-425-5550
Practice Address - Street 1:27 ORCHARD ST
Practice Address - Street 2:SUITE 207
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3047
Practice Address - Country:US
Practice Address - Phone:845-425-2617
Practice Address - Fax:845-425-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01000345500OtherAMERICHOICE OF NJ
NJ38126OtherUHP
NY137313OtherWELLCARE
NYG71501OtherEMPIRE BLUE CROSS BLUE
NY01793719Medicaid
NY01806000Medicaid
NY01399866Medicaid
NYA1304060OtherOXFORD
NYANC002201OtherAMERICHOICE OF NY
NY1000017829OtherAFFINITY HEALTH PLAN
NJ1163582OtherHORIZON NJ HEALTH
NY4579434OtherAETNA
NY000412358467OtherHEALTH PLUS