1215234877 NPI number — RONALD L LEHNOWSKY DDS INC

Table of content: JEANAE ELYSE DEDIO PHYSICIAN ASSISTANT (NPI 1558144865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215234877 NPI number — RONALD L LEHNOWSKY DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD L LEHNOWSKY DDS INC
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:
1215234877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1670 COOPER FOSTER PARK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LORAIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44053-3658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-960-1299
Provider Business Mailing Address Fax Number:
440-960-2169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 COOPER FOSTER PARK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORAIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44053-3658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-960-1299
Provider Business Practice Location Address Fax Number:
440-960-2169
Provider Enumeration Date:
02/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEHNOWSKY
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-960-1299

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  30013414 , 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: 0184992 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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