Healthcare Provider Details

I. General information

NPI: 1225218159
Provider Name (Legal Business Name): DIABETIC FOOTWEAR & SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7036 W PALMETTO PARK RD SUITE 59
BOCA RATON FL
33433-3404
US

IV. Provider business mailing address

7036 W PALMETTO PARK RD SUITE 59
BOCA RATON FL
33433-3404
US

V. Phone/Fax

Practice location:
  • Phone: 561-338-3838
  • Fax: 561-338-5318
Mailing address:
  • Phone: 561-338-3838
  • Fax: 561-338-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL J. WEINER
Title or Position: PRESIDENT
Credential: CERTIFIED PEDORTHIST
Phone: 561-338-3838