1124157805 NPI number — MS. EDITH CIOTOLA SCHROEDER M.S

Table of content: MS. EDITH CIOTOLA SCHROEDER M.S (NPI 1124157805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124157805 NPI number — MS. EDITH CIOTOLA SCHROEDER M.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROEDER
Provider First Name:
EDITH
Provider Middle Name:
CIOTOLA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CIOTOLA
Provider Other First Name:
EDITH
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124157805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 MARION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44514-3725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-757-3022
Provider Business Mailing Address Fax Number:
330-782-8785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 90
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-782-7701
Provider Business Practice Location Address Fax Number:
330-782-8785
Provider Enumeration Date:
03/05/2007

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:  C0004372 , 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)





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