MEDICARE: YEHUDA'S SHOES INC.

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1609013499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YEHUDA'S SHOES INC.

Provider Business Mailing Address
First Line	:	3922 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5804
Country	:	US
Telephone Number	:	718-438-6954
Fax Number	:

Provider Business Practice Location Address
First Line	:	3922 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5804
Country	:	US
Telephone Number	:	718-438-6954
Fax Number	:

Authorized Official
Title or Position	:	PRES.
Name	:	MR. ALEX A ISKHAKOV
Credential	:	CFTS
Telephone Number	:	646-335-7857

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/15/2009

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