1477523462 NPI number — MRS. JEANINE A BITSKAY DC

Table of content: MRS. JEANINE A BITSKAY DC (NPI 1477523462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477523462 NPI number — MRS. JEANINE A BITSKAY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BITSKAY
Provider First Name:
JEANINE
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1477523462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 KIMBERLY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44217-9425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-620-1159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 E SMITH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44256-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-725-5277
Provider Business Practice Location Address Fax Number:
330-725-4241
Provider Enumeration Date:
01/24/2006

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:  1734 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000139761 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0857210 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20813900 . This is a "US DEPT. OF LABOR-GROUP#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341774514-00 . This is a "WORKER'S COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0221638 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34182024800 . This is a "GROUP WORKERS COMP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1734 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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