Organization
FRED'S BOOT SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IGNAZIO CANCELLIERI CPED, BOC OC, ABC OC (OWNER)
(585) 303-1886
Entity
Organization
Contact information
Practice address
2854 DEWEY AVE, ROCHESTER, NY 14616-4630
(585) 303-1886
(585) 227-8562
Mailing address
186 RED HICKORY DR, ROCHESTER, NY 14626-4033
(585) 303-1886
(585) 227-8562
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106685GD
PREFERRED CARE
NY
Enumeration date
11/14/2006
Last updated
08/22/2020
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