1982799151 NPI number — DR. FRED L SANFILIPO DC

Table of content: DR. FRED L SANFILIPO DC (NPI 1982799151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982799151 NPI number — DR. FRED L SANFILIPO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANFILIPO
Provider First Name:
FRED
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982799151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2755 BUFFALO RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14624-1337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-426-1576
Provider Business Mailing Address Fax Number:
585-426-7888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2755 BUFFALO RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14624-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-426-1576
Provider Business Practice Location Address Fax Number:
585-426-7888
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  30058 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111NX0800X , with the licence number: 30058 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PO10003005 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PO10003005 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101859AN . This is a "PREF CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5173481 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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