Provider Demographics
NPI:1669621116
Name:SORRENTINO BOOTS & BRITCHES
Entity type:Organization
Organization Name:SORRENTINO BOOTS & BRITCHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-792-6361
Mailing Address - Street 1:60 N. CANFIELD NILES RD
Mailing Address - Street 2:STE 800
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2341
Mailing Address - Country:US
Mailing Address - Phone:330-792-6361
Mailing Address - Fax:330-729-6383
Practice Address - Street 1:60 N CANFIELD NILES RD
Practice Address - Street 2:STE 800
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2340
Practice Address - Country:US
Practice Address - Phone:330-792-6361
Practice Address - Fax:330-792-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPED-0067335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4139350001Medicare NSC