Organization
DOC SHOES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN J. MULCAHY C-PED (CERTIFIED PEDORTHIST)
(908) 349-8014
Entity
Organization
Contact information
Practice address
2717 MORRIS AVENUE, UNION, NJ 07083
(908) 349-8014
(908) 349-8014
Mailing address
2717 MORRIS AVENUE, UNION, NJ 07083
(908) 349-8014
(908) 349-8014
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
964
MN
335E00000X
Prosthetic/Orthotic Supplier
964
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8502501
—
NJ
Enumeration date
03/06/2008
Last updated
05/27/2009
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