Provider Demographics
NPI:1396987327
Name:ERIE SHORES FOOT AND ANKLE SPECIALISTS INC
Entity type:Organization
Organization Name:ERIE SHORES FOOT AND ANKLE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETROZZI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-290-5327
Mailing Address - Street 1:1636 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4679
Mailing Address - Country:US
Mailing Address - Phone:440-290-5327
Mailing Address - Fax:440-290-5328
Practice Address - Street 1:1636 N SHORE DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4679
Practice Address - Country:US
Practice Address - Phone:440-290-5327
Practice Address - Fax:440-290-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty