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General NPI Number Information
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NPI Number | 1730041658
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Entity Type | Organization
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Legal Business Name | SHOEDOC LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 20 ISRAEL ZUPNICK DR UNIT 117
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City | MONROE
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State | NY
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Zip | 10950-6670
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Country | US
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Telephone | 845-746-2024
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Fax |
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Provider Business Mailing Address
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Address Line | 625 SADDLE RIVER RD
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City | AIRMONT
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State | NY
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Zip | 10952-4812
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Country | US
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Telephone | 845-988-7148
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH KELLNER
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Credential |
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Telephone | 845-988-7148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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