Healthcare Provider Details

I. General information

NPI: 1124216924
Provider Name (Legal Business Name): HARRIETS INNERWEAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E PASSYUNK AVE
PHILADELPHIA PA
19148-1517
US

IV. Provider business mailing address

1725 E PASSYUNK AVE
PHILADELPHIA PA
19148-1517
US

V. Phone/Fax

Practice location:
  • Phone: 215-468-5100
  • Fax:
Mailing address:
  • Phone: 215-468-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name: BARBARA SHAPIRO
Title or Position: OWNER
Credential:
Phone: 215-468-5100