Provider Demographics
NPI:1083772644
Name:DELLIGATTI SHOES
Entity Type:Organization
Organization Name:DELLIGATTI SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARUNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:OST
Authorized Official - Phone:724-438-5401
Mailing Address - Street 1:659 PITTSBURGH RD
Mailing Address - Street 2:DELLIGATTI SHOES
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-438-5401
Mailing Address - Fax:724-438-5402
Practice Address - Street 1:659 PITTSBURGH RD
Practice Address - Street 2:DELLIGATTI SHOES
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2215
Practice Address - Country:US
Practice Address - Phone:724-438-5401
Practice Address - Fax:724-438-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0090506OtherUMWA
PA64433Medicaid
PA1507749OtherGATEWAY
PA1507749OtherGATEWAY
PA64433Medicaid