1679724884 NPI number — NEIGHBORHOOD PEDIATRICS, LLC

Table of content: MATTHEW JOHNSON BA, LADC (NPI 1639462211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679724884 NPI number — NEIGHBORHOOD PEDIATRICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORHOOD PEDIATRICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1679724884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14701 DETROIT AVE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-221-5901
Provider Business Mailing Address Fax Number:
216-221-5881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14701 DETROIT AVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44107-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-221-5901
Provider Business Practice Location Address Fax Number:
216-221-5881
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILOVANOVIC
Authorized Official First Name:
PAULINE
Authorized Official Middle Name:
HELEN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
216-221-5901

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  35057882 , 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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