MEDICARE: ENESLOW PEDORTHIC ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies	1134201	NY

General Provider Information

NPI Number	:	1306869136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENESLOW PEDORTHIC ENTERPRISES INC

Provider Business Mailing Address
First Line	:	470 PARK AVENUE SOUTH
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6819
Country	:	US
Telephone Number	:	212-477-2300
Fax Number	:	212-477-2156

Provider Business Practice Location Address
First Line	:	470 PARK AVENUE SOUTH
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6819
Country	:	US
Telephone Number	:	212-477-2300
Fax Number	:	212-477-2156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT S SCHWARTZ
Credential	:	CPED
Telephone Number	:	212-477-2300

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/08/2010

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