Provider Demographics
NPI:1821314600
Name:NATIONAL DIABETIC SHOE COMPANY LLC
Entity Type:Organization
Organization Name:NATIONAL DIABETIC SHOE COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EFREM
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-269-9004
Mailing Address - Street 1:647 STATE ROUTE 18
Mailing Address - Street 2:STE M
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3747
Mailing Address - Country:US
Mailing Address - Phone:732-387-8541
Mailing Address - Fax:
Practice Address - Street 1:647 STATE ROUTE 18
Practice Address - Street 2:STE M
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3747
Practice Address - Country:US
Practice Address - Phone:732-387-8541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6449280001Medicare PIN