1669621116 NPI number — SORRENTINO BOOTS & BRITCHES

Table of content: (NPI 1669621116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669621116 NPI number — SORRENTINO BOOTS & BRITCHES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SORRENTINO BOOTS & BRITCHES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669621116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 N. CANFIELD NILES RD
Provider Second Line Business Mailing Address:
STE 800
Provider Business Mailing Address City Name:
AUSTINTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44515-2341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-792-6361
Provider Business Mailing Address Fax Number:
330-729-6383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 N CANFIELD NILES RD
Provider Second Line Business Practice Location Address:
STE 800
Provider Business Practice Location Address City Name:
AUSTINTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44515-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-792-6361
Provider Business Practice Location Address Fax Number:
330-792-6383
Provider Enumeration Date:
09/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SORRENTINO
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-792-6361

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  LPED-0067 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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