Organization
ORTHO SHOES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GABRIYEL ADZHIASHVILI CPED (PRESIDENT)
(917) 304-6657
Entity
Organization
Contact information
Practice address
10032 QUEENS BLVD, FOREST HILLS, NY 11375-2748
(917) 304-6657
Mailing address
10032 QUEENS BLVD, FOREST HILLS, NY 11375-2748
(917) 304-6657
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
CPED 3003
DE
Other
Enumeration date
11/04/2009
Last updated
07/08/2020
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