1710970108 NPI number — DR. CYNTHIA S FERRELLI DPM

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710970108 NPI number — DR. CYNTHIA S FERRELLI DPM

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FERRELLI

Provider First Name:

CYNTHIA

Provider Middle Name:

S

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

DPM

Provider Gender Code:

F

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:

1710970108

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

330 HARRIS HILL RD

Provider Second Line Business Mailing Address:

SUITE B

Provider Business Mailing Address City Name:

BUFFALO

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

14221-7407

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

716-631-1133

Provider Business Mailing Address Fax Number:

716-631-3030

Provider First Line Business Practice Location Address:

330 HARRIS HILL RD

Provider Second Line Business Practice Location Address:

SUITE B

Provider Business Practice Location Address City Name:

BUFFALO

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

14221-7407

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

716-631-1133

Provider Business Practice Location Address Fax Number:

716-631-3030

Provider Enumeration Date:

08/31/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213E00000X , with the licence number:  NY0046741 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 213ES0131X , with the licence number: NY004674-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

• Identifier: BC ROCHESTER . This is a "P01004674" identifier . This identifiers is of the category "OTHER".
• Identifier: MCR SHOE PROGRAM . This is a "0996190001" identifier . This identifiers is of the category "OTHER".
• Identifier: P046749B . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
• Identifier: 00052799400 . This is a "BC ORTHOTICS ETC" identifier . This identifiers is of the category "OTHER".
• Identifier: 0892504 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0004413215 . This is a "AETNA EL PASO TX" identifier . This identifiers is of the category "OTHER".
• Identifier: 01215118 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: GHI . This is a "6200202" identifier . This identifiers is of the category "OTHER".
• Identifier: 5279945 . This is a "CB ORTHOTIC PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 00010252502 . This is a "UNIVERA AND SENIOR CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: P6348 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 8990329 . This is a "IHA" identifier . This identifiers is of the category "OTHER".