1710073705 NPI number — JOHN X BIONDI MD

Table of content: JOHN X BIONDI MD (NPI 1710073705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710073705 NPI number — JOHN X BIONDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIONDI
Provider First Name:
JOHN
Provider Middle Name:
X
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1710073705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3925 EMBASSY PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-8400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-668-4040
Provider Business Mailing Address Fax Number:
330-668-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3925 EMBASSY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-1782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-668-4040
Provider Business Practice Location Address Fax Number:
330-668-1453
Provider Enumeration Date:
10/05/2006

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: 207X00000X , with the licence number:  35050648 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 35.050648 , 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: 200032670 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0713437 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".