1073610721 NPI number — COMFORT ZONE SHOES AND FOOTBEDS LLC

Table of content: AHSAN RAZA KHAN MD (NPI 1467121244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073610721 NPI number — COMFORT ZONE SHOES AND FOOTBEDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORT ZONE SHOES AND FOOTBEDS LLC
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:
Provider Other Organization Name Type Code:
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:
1073610721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 E MAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02871-2340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 E MAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02871-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-682-2116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROW
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
OWNDER/PEDORTHIST
Authorized Official Telephone Number:
401-682-2116

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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