1114962628 NPI number — DR. LYNN GOLDSTEIN SALZBRENNER AUD

Table of content: DR. LYNN GOLDSTEIN SALZBRENNER AUD (NPI 1114962628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114962628 NPI number — DR. LYNN GOLDSTEIN SALZBRENNER AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALZBRENNER
Provider First Name:
LYNN
Provider Middle Name:
GOLDSTEIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

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:
1114962628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 BRUNSWICK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44236-1411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-463-0149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5010 MAYFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
LYNDHURST
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-381-5011
Provider Business Practice Location Address Fax Number:
216-381-9277
Provider Enumeration Date:
06/18/2006

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: 231H00000X , with the licence number:  0422 , 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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