1861665606 NPI number — NORMAN W LEFKOVITZ

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861665606 NPI number — NORMAN W LEFKOVITZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN W LEFKOVITZ
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:
1861665606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 N MILLER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRLAWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-3702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-864-9099
Provider Business Mailing Address Fax Number:
330-864-9390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 N MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRLAWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-864-9099
Provider Business Practice Location Address Fax Number:
330-864-9390
Provider Enumeration Date:
04/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHRISTIE
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICAL ASSISTANT
Authorized Official Telephone Number:
330-864-9099

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  35-04-9231 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP3300X , with the licence number: 35-04-9231 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , with the licence number: 35-04-9231 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0630820 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".