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
Update your record
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