Provider Demographics
NPI:1801035233
Name:COMFORT SHOES AND SUPPLIES, INC
Entity Type:Organization
Organization Name:COMFORT SHOES AND SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMITROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CFO, CFT
Authorized Official - Phone:201-943-0340
Mailing Address - Street 1:659 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1927
Mailing Address - Country:US
Mailing Address - Phone:201-943-0340
Mailing Address - Fax:201-943-0347
Practice Address - Street 1:659 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1927
Practice Address - Country:US
Practice Address - Phone:201-943-0340
Practice Address - Fax:201-943-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCFO03082332B00000X
NJCFTS0148332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60085923OtherHORIZON NJ HEALTH
NJ6209150001Medicare NSC