Provider Demographics
NPI:1205122744
Name:PRECIOUS ORTHOTIC & DIABETIC FOOT WEAR, LLC
Entity type:Organization
Organization Name:PRECIOUS ORTHOTIC & DIABETIC FOOT WEAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIIED SHOE FITTER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-752-8881
Mailing Address - Street 1:6 ANDREW STREET
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812
Mailing Address - Country:US
Mailing Address - Phone:732-752-8881
Mailing Address - Fax:
Practice Address - Street 1:6 ANDREW ST
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2504
Practice Address - Country:US
Practice Address - Phone:732-752-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies