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Organization

A CUSTOM COMFORT SHOES INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT DULBERG (PRESIDENT)
(954) 457-1202
Entity
Organization

Contact information

Practice address
800 E HALLANDALE BEACH BLVD, SUITE 23, HALLANDALE BEACH, FL 33009-4477
(954) 457-1202
(954) 454-9971
Mailing address
800 E HALLANDALE BEACH BLVD, SUITE 23, HALLANDALE BEACH, FL 33009-4477
(954) 457-1202
(954) 454-9971

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PED15
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
M1031
BLUECROSS BLUESHIELD
FL
Enumeration date
05/04/2007
Last updated
12/04/2007
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