Healthcare Provider Details

I. General information

NPI: 1275501546
Provider Name (Legal Business Name): SHOETECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 DEWEY AVE
ROCHESTER NY
14616-4630
US

IV. Provider business mailing address

186 RED HICKORY DR
ROCHESTER NY
14626-4033
US

V. Phone/Fax

Practice location:
  • Phone: 585-303-1886
  • Fax: 585-227-8562
Mailing address:
  • Phone: 585-303-1886
  • Fax: 585-227-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. IGNAZIO CANCELLIERI
Title or Position: OWNER
Credential: CO, C.PED
Phone: 585-303-1886