NPIMap

Organization Active NPI

Italy Shoe Lab, Inc

  • Prosthetic/Orthotic Supplier
  • Wimauma, FL
National Provider Identifier
1962455873
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
NO PED 76 Issued in FL
Legal business name
ITALY SHOE LAB, INC
Practice address
16621 Hwy 301 S
#107
Wimauma, FL 33598
Phone
(813) 645-5800
Fax
(813) 641-0319
NPI assigned
May 19, 2006
Last updated
Feb 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Authorized official

Name
Jeffrey M Corniello, CPED
Title
Vice-President
Phone
(813) 645-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X NO PED 76 FL Primary

Addresses

Primary practice location

16621 Hwy 301 S
#107
Wimauma, FL 33598

Mailing address

13521 Mango Bay Dr
Riverview, FL 33579-2336
Phone (813) 645-5800

National Provider Directory

National Provider Directory
Tax ID family
Italy Shoe Lab Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

16621 S US Highway 301
#107
Wimauma, FL 33598
Phone (813) 645-5800

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1962455873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13521 MANGO BAY DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335792336",
            "telephone_number": "813-645-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16621 HWY 301 S",
            "address_2": "#107",
            "city": "WIMAUMA",
            "state": "FL",
            "postal_code": "33598",
            "telephone_number": "813-645-5800",
            "fax_number": "813-641-0319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITALY SHOE LAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "CORNIELLO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "813-645-5800",
        "authorized_official_credential": "CPED"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "FL",
            "license": "NO PED 76",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wimauma, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; 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.