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General NPI Number Information
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NPI Number | 1801035233
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Entity Type | Organization
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Legal Business Name | COMFORT SHOES AND SUPPLIES, INC
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 659 ANDERSON AVE
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-1927
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Country | US
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Telephone | 201-943-0340
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Fax | 201-943-0347
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Provider Business Mailing Address
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Address Line | 659 ANDERSON AVE
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-1927
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Country | US
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Telephone | 201-943-0340
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Fax | 201-943-0347
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. YANA DIMITROVICH
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Credential | CFO, CFT
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Telephone | 201-943-0340
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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 | CFTS0148
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | CFO03082
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License Number State | NJ
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