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General NPI Number Information
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NPI Number | 1841402377
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Entity Type | Organization
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Legal Business Name | A CUSTOM COMFORT SHOES INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 800 E HALLANDALE BEACH BLVD SUITE 23
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4477
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Country | US
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Telephone | 954-457-1202
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Fax | 954-454-9971
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Provider Business Mailing Address
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Address Line | 800 E HALLANDALE BEACH BLVD SUITE 23
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4477
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Country | US
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Telephone | 954-457-1202
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Fax | 954-454-9971
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT DULBERG
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Credential |
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Telephone | 954-457-1202
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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 | PED15
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License Number State | FL
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