Organization
SUSAN SCHEFTICS MASTECTOMY BOUTIQUE
Active
Other names
Lady Jane Mastectomy Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN SCHEFTIC (OWNER)
(315) 498-9086
Entity
Organization
Contact information
Practice address
5700 W GENESEE ST, CAMILLUS, NY 13031-3200
(315) 468-9743
(315) 468-9744
Mailing address
5700 W GENESEE ST, CAMILLUS, NY 13031-3200
(315) 468-9743
(315) 468-9744
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01505022
—
NY
Enumeration date
12/07/2007
Last updated
12/27/2011
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