| Organization Name: | THE PEDORTHIC SHOPPE INC |
| NPI Number: | 1134279326 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELANGELO SCAFIDI (OWNER PRESIDENT) |
| Mailing Address: | 8344 W Lawrence Ave Norridge |
| State: | IL US |
| Postal Code: | 607063152 |
| Phone Number: | 7084534900 |
| Fax Number: | 7084533338 |
| NPI Enumeration Date: | 01/11/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 332BC3200X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |