1396742557 NPI number — MEDICAL ONCOLOGY ASSOCIATES, INC.

Table of content: ALLISON MALNIK LMHC (NPI 1932795762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396742557 NPI number — MEDICAL ONCOLOGY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ONCOLOGY ASSOCIATES, 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:
1396742557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29349 GATES MILLS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEPPER PIKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-4651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-831-6493
Provider Business Mailing Address Fax Number:
216-831-6413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2412 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHTABULA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44004-4977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-997-7785
Provider Business Practice Location Address Fax Number:
440-998-0652
Provider Enumeration Date:
07/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VARGHAI
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-997-7785

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  35 . 053339 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0200X , with the licence number: 35 . 053339 , 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: 0858602 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0971355 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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