=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780873554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POLMED COMFORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2007
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 BELMONT AVE
-----------------------------------------------------
City | GARFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07026-3258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-546-3435
-----------------------------------------------------
Fax | 973-645-3436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 BELMONT AVE
-----------------------------------------------------
City | GARFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07026-3258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-546-3435
-----------------------------------------------------
Fax | 973-645-3436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MISS GALINA BRANCEWICZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-546-3435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------