Provider Demographics
NPI:1790702231
Name:KIDS FEET LLC
Entity Type:Organization
Organization Name:KIDS FEET LLC
Other - Org Name:KATES BROS SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDORTHIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:973-229-7084
Mailing Address - Street 1:329 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-487-1779
Mailing Address - Fax:201-487-1780
Practice Address - Street 1:329 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-487-1779
Practice Address - Fax:201-487-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5731060001Medicare NSC