MEDICARE: PRECISION SHOE BRACE & LIMBS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	45PO00007500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255582128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION SHOE BRACE & LIMBS LLC

Provider Business Mailing Address
First Line	:	1025 WEST ST. GEORGES AVENUE - SUITE 3
Second Line	:	PO BOX 1213
City	:	LINDEN
State	:	NJ
Zip	:	07036-6134
Country	:	US
Telephone Number	:	908-486-8636
Fax Number	:	908-523-0036

Provider Business Practice Location Address
First Line	:	1025 W SAINT GEORGES AVE STE 3
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-6134
Country	:	US
Telephone Number	:	908-486-8636
Fax Number	:	908-523-0036

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL D GOODMAN
Credential	:	C.P.O
Telephone Number	:	908-486-8636

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	08/07/2025

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