Provider Demographics
NPI:1538178215
Name:VAN OSTEN FOOTWEAR LLC
Entity type:Organization
Organization Name:VAN OSTEN FOOTWEAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN OSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:201-934-1515
Mailing Address - Street 1:8 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1923
Mailing Address - Country:US
Mailing Address - Phone:201-934-1515
Mailing Address - Fax:201-934-4080
Practice Address - Street 1:8 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1923
Practice Address - Country:US
Practice Address - Phone:201-934-1515
Practice Address - Fax:201-934-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4354470001Medicare ID - Type Unspecified