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General NPI Number Information
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NPI Number | 1386660751
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Entity Type | Organization
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Legal Business Name | SHOE PRO CORP
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 14431 41ST AVE SUITE # L6
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City | FLUSHING
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State | NY
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Zip | 11355-1459
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Country | US
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Telephone | 718-359-3348
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Fax | 718-359-0388
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Provider Business Mailing Address
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Address Line | 14431 41ST AVE SUITE # L6
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City | FLUSHING
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State | NY
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Zip | 11355-1459
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Country | US
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Telephone | 718-359-3348
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Fax | 718-359-0388
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HONG J LEE
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Credential | CERTIFIED PEDORTHIST
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Telephone | 718-359-3348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 3105
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License Number State | NY
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