Organization
THE SHOE TRAVELER DIABETIC FOOTWEAR AND MEDICAL SUPPLIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA MIGLIACCIO CERTIFIED PEDORTHIST (OWNER/PRESIDENT)
(732) 462-1005
Entity
Organization
Contact information
Practice address
1214 ROUTE 9 S, HOWELL, NJ 07731-3329
(732) 462-1005
(732) 276-2369
Mailing address
647 WINTERBERRY BLVD, JACKSON, NJ 08527-5344
(732) 462-1005
(732) 276-2369
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CERTIFIED PEDORTHIST
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0244414
—
NJ
Enumeration date
12/28/2008
Last updated
09/19/2012
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