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General NPI Number Information
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NPI Number | 1982785077
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Entity Type | Organization
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Legal Business Name | DESIGNER COMFORT SHOES CENTER INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1669 PITKIN AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11212
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Country | US
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Telephone | 718-498-3501
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Fax |
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Provider Business Mailing Address
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Address Line | 1669 PITKIN AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11212
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Country | US
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Telephone | 718-498-3501
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Fax |
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Authorized Official
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Title or Position | PEDORTHIST
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Name | MRS. LARISA SIMKHAEV
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Credential | PA
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Telephone | 917-704-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PENDING
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License Number State | NY
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