Provider Demographics
NPI:1477610400
Name:SAMMY & DIVINCENZO, PA
Entity Type:Organization
Organization Name:SAMMY & DIVINCENZO, PA
Other - Org Name:BRADENTON PODIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMDIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SAMMY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-753-1234
Mailing Address - Street 1:3003 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-3739
Mailing Address - Country:US
Mailing Address - Phone:941-753-1234
Mailing Address - Fax:941-755-1332
Practice Address - Street 1:3003 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-3739
Practice Address - Country:US
Practice Address - Phone:941-753-1234
Practice Address - Fax:941-755-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF1471OtherRAILROAD MEDICARE
FLCF1471Medicare PIN
FL1247430001Medicare NSC