Provider Demographics
NPI:1588739551
Name:PURPURI SHOES INC
Entity type:Organization
Organization Name:PURPURI SHOES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PURPURI
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:732-349-2183
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7435
Mailing Address - Country:US
Mailing Address - Phone:732-349-2183
Mailing Address - Fax:732-349-3783
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7435
Practice Address - Country:US
Practice Address - Phone:732-349-2183
Practice Address - Fax:732-349-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4582220001Medicare NSC