1942351507 NPI number — SARA GRANOFF-SCHOR, DPM, INC.

Table of content: (NPI 1942351507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942351507 NPI number — SARA GRANOFF-SCHOR, DPM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARA GRANOFF-SCHOR, DPM, INC.
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:
1942351507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 RESERVOIR AVE
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02910-4446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-944-4770
Provider Business Mailing Address Fax Number:
401-944-4771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 RESERVOIR AVE
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02910-4446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-944-4770
Provider Business Practice Location Address Fax Number:
401-944-4771
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRANOFF-SCHOR
Authorized Official First Name:
SARA
Authorized Official Middle Name:
ROBIN
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
401-944-4770

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  DPM00226 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: DPM00257 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000257 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 004590 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2262449 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 27-00172 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 480026885 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: SG07157 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942351507 . This is a "NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 33398 . This is a "PILGRIM" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0137578005 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 70010000ZBC069 . This is a "BLUE CROSS MASSACHUSETTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7064-4 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: DPM00257 . This is a "RI LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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