Provider Demographics
NPI:1629420120
Name:COMFORT ORTHOTICS, LLC
Entity Type:Organization
Organization Name:COMFORT ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIDCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-716-1998
Mailing Address - Street 1:8 NESHAMINY INTERPLEX
Mailing Address - Street 2:STE 112
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6933
Mailing Address - Country:US
Mailing Address - Phone:215-716-1998
Mailing Address - Fax:215-716-1998
Practice Address - Street 1:8 NESHAMINY INTERPLEX
Practice Address - Street 2:STE 112
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6933
Practice Address - Country:US
Practice Address - Phone:215-716-1998
Practice Address - Fax:215-716-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7571880001Medicare NSC