Provider Demographics
NPI:1861516791
Name:CORRECT SHOE FITTERS
Entity type:Organization
Organization Name:CORRECT SHOE FITTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN KOFMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-438-0032
Mailing Address - Street 1:118 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1959
Mailing Address - Country:US
Mailing Address - Phone:201-438-0032
Mailing Address - Fax:201-438-9407
Practice Address - Street 1:118 PARK AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1959
Practice Address - Country:US
Practice Address - Phone:201-438-0032
Practice Address - Fax:201-438-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4513401Medicaid
NJ4513401Medicaid