Provider Demographics
NPI:1861650962
Name:SOLUP SHOE INC
Entity Type:Organization
Organization Name:SOLUP SHOE INC
Other - Org Name:SOLUP SHOE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOLUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-324-4800
Mailing Address - Street 1:130 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:ME
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:ME
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-324-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1359920001Medicare NSC