Provider Demographics
NPI:1558576009
Name:MANOR SHOES INC.
Entity Type:Organization
Organization Name:MANOR SHOES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANETTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-836-5835
Mailing Address - Street 1:461 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1708
Mailing Address - Country:US
Mailing Address - Phone:201-836-5835
Mailing Address - Fax:
Practice Address - Street 1:461 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1708
Practice Address - Country:US
Practice Address - Phone:201-836-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0739560001Medicare ID - Type Unspecified