Provider Demographics
NPI:1275254062
Name:GINOS SHOE STORE INC
Entity Type:Organization
Organization Name:GINOS SHOE STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GINOCCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-675-2029
Mailing Address - Street 1:2437 SR 309 HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9251
Mailing Address - Country:US
Mailing Address - Phone:570-675-2029
Mailing Address - Fax:
Practice Address - Street 1:2437 SR 309 HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9251
Practice Address - Country:US
Practice Address - Phone:570-675-2029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies