Fred'S Boot Shop

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

FRED'S BOOT SHOP

Practice address

2854 Dewey Ave
Rochester, NY 14616-4630

Phone

(585) 303-1886

Fax

(585) 227-8562

NPI assigned

Nov 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ignazio Cancellieri, CPED, BOC OC, ABC OC

Title

Owner

Phone

(585) 303-1886

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Fred'S Boot Shop2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shoetech

  • Durable Medical Equipment & Medical Supplies
  • Rochester, NY
  • NPI 1275501546
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841362001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 RED HICKORY DR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264033",
            "telephone_number": "585-303-1886",
            "fax_number": "585-227-8562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2854 DEWEY AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146164630",
            "telephone_number": "585-303-1886",
            "fax_number": "585-227-8562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED'S BOOT SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CANCELLIERI",
        "authorized_official_first_name": "IGNAZIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "585-303-1886",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPED, BOC OC, ABC OC"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "106685GD",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric Frazier, PHARM.D.
• Gloria Jean Frazier
• John Frazier
• Suzanna Lee Frazier
• Shannon Elizabeth Frear, PA-C
• Sondra Ann Freda, LMHC
• Kara Anne Fredette-Benitez, LMSW
• Rachael Christine Freedman, PMHNP-BC
• Zachary Freedman, M.D.
• Freedom of Choice OB/GYN Services of Western New York

• Durable Medical Equipment & Medical Supplies in Rochester, NY
• Providers in Rochester, NY by specialty
• Durable Medical Equipment & Medical Supplies in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.