Healthcare Provider Details

I. General information

NPI: 1710005988
Provider Name (Legal Business Name): A & J SHOE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 WESTPORT AVE
NORWALK CT
06851
US

IV. Provider business mailing address

499 WESTPORT AVE
NORWALK CT
06851
US

V. Phone/Fax

Practice location:
  • Phone: 203-847-9400
  • Fax: 203-845-0304
Mailing address:
  • Phone: 203-847-9400
  • Fax: 203-845-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA LEE LEVY
Title or Position: PEDORTHIST
Credential: CPED
Phone: 203-847-9400