1063734002 NPI number — SURGICAL SOCK SHOP INC

Table of content: (NPI 1063734002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063734002 NPI number — SURGICAL SOCK SHOP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SOCK SHOP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOLESEMART
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063734002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JOSHUA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONSEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10952-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-425-2617
Provider Business Mailing Address Fax Number:
845-425-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 ROMAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONSEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10952-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-356-0049
Provider Business Practice Location Address Fax Number:
845-356-0049
Provider Enumeration Date:
02/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
DEVORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-356-0049

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)