Provider Demographics
NPI:1891080230
Name:PENNLEE FOOTWEAR
Entity Type:Organization
Organization Name:PENNLEE FOOTWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-825-5346
Mailing Address - Street 1:163 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18705-2813
Mailing Address - Country:US
Mailing Address - Phone:500-825-5346
Mailing Address - Fax:570-825-1491
Practice Address - Street 1:163 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18705-2813
Practice Address - Country:US
Practice Address - Phone:500-825-5346
Practice Address - Fax:570-825-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier