| NPI | 1386822104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY MARC MICKENBERG Owner 410-255-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MD 01053) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 01053) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2011-04-14 |