Healthcare Provider Details

I. General information

NPI: 1932299369
Provider Name (Legal Business Name): DI SALVO SHOE STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BATAVIA CITY CENTRE
BATAVIA NY
14020
US

IV. Provider business mailing address

6 BATAVIA CITY CENTRE
BATAVIA NY
14020
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-4747
  • Fax: 585-343-4747
Mailing address:
  • Phone: 585-343-4747
  • Fax: 585-343-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD JAMES DISALVO
Title or Position: PRES
Credential:
Phone: 585-343-4747