Provider Demographics
NPI:1619007333
Name:IMPERATO, SALVATORE N (HEARING INSTRUMENT S)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:N
Last Name:IMPERATO
Suffix:
Gender:M
Credentials:HEARING INSTRUMENT S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 MAIN STREET SOUTH
Mailing Address - Street 2:PO BOX 78
Mailing Address - City:SOUTH BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01074
Mailing Address - Country:US
Mailing Address - Phone:978-355-2191
Mailing Address - Fax:978-355-2020
Practice Address - Street 1:395 MAIN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:SOUTH BARRE
Practice Address - State:MA
Practice Address - Zip Code:01074
Practice Address - Country:US
Practice Address - Phone:978-355-2191
Practice Address - Fax:978-355-2020
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4043156FC0800X, 156FX1800X
MA0034174400000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No174400000XOther Service ProvidersSpecialist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028800BOtherMASSHEALTH
MA45806OtherFALLON
MA1537903Medicaid
MA95162501OtherNETWORKHEALTH
MA110028800AOtherMASSHEALTH HEARING
MAOP2873OtherEYEMED
MABAROPT123OtherUNICARE