Provider Demographics
NPI:1952671208
Name:MALKIN'S SHOES LLC
Entity Type:Organization
Organization Name:MALKIN'S SHOES LLC
Other - Org Name:MALKIN'S FUNCTIONAL FOOTWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-220-1800
Mailing Address - Street 1:1 RUTH ST
Mailing Address - Street 2:
Mailing Address - City:E BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1415
Mailing Address - Country:US
Mailing Address - Phone:732-220-1800
Mailing Address - Fax:732-220-1971
Practice Address - Street 1:1 RUTH ST
Practice Address - Street 2:
Practice Address - City:E BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1415
Practice Address - Country:US
Practice Address - Phone:732-220-1800
Practice Address - Fax:732-220-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6712410001Medicare NSC