Healthcare Provider Details

I. General information

NPI: 1194861906
Provider Name (Legal Business Name): SMOLENSKY SHOE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 BRIDGEPORT AVE
SHELTON CT
06484-4625
US

IV. Provider business mailing address

862 BRIDGEPORT AVE
SHELTON CT
06484-4625
US

V. Phone/Fax

Practice location:
  • Phone: 203-712-1300
  • Fax: 203-712-1314
Mailing address:
  • Phone: 203-712-1300
  • Fax: 203-712-1314

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: ROBERT B SMOLENSKY
Title or Position: PRES
Credential:
Phone: 203-712-1300