1942472139 NPI number — ROBERT J. SHELLITO DPM, INC.

Table of content: (NPI 1942472139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942472139 NPI number — ROBERT J. SHELLITO DPM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT J. SHELLITO 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:
6
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:
1942472139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUBBARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44425-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-534-4438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1543 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44483-6639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-392-2700
Provider Business Practice Location Address Fax Number:
330-392-2707
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHELLITO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JUDE
Authorized Official Title or Position:
PRESIDENT/PODIATRIST
Authorized Official Telephone Number:
330-534-4438

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36003129 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: SC005955 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2154163 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101757359 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com