1841358538 NPI number — DR. JONI L GRIM-KRZYCKI PHD

Table of content: DR. JONI L GRIM-KRZYCKI PHD (NPI 1841358538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841358538 NPI number — DR. JONI L GRIM-KRZYCKI PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIM-KRZYCKI
Provider First Name:
JONI
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRZYCKI
Provider Other First Name:
JONI
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841358538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 ARDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43214-3704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-619-2259
Provider Business Mailing Address Fax Number:
614-847-9322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W WILSON BRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
WORTHINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43085-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-619-2259
Provider Business Practice Location Address Fax Number:
614-847-9322
Provider Enumeration Date:
12/05/2006

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: 101YP2500X , with the licence number:  E-4047 SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: OH 6321 , 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)