Provider Demographics
NPI:1760552269
Name:THE FITTING ROOM INC
Entity Type:Organization
Organization Name:THE FITTING ROOM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:BOC CMF
Authorized Official - Phone:440-282-1145
Mailing Address - Street 1:1320 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3614
Mailing Address - Country:US
Mailing Address - Phone:440-282-1145
Mailing Address - Fax:440-282-1165
Practice Address - Street 1:1320 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3614
Practice Address - Country:US
Practice Address - Phone:440-282-1145
Practice Address - Fax:440-282-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000155880OtherANTHEM
8000303OtherUNITEDHEALTH CARE
OH0196032Medicaid
5804421OtherAETNA
=========0002OtherCIGNA
OH=========005OtherMEDICAL MUTUAL
=========0002OtherCIGNA