1427199033 NPI number — DR. RAYMOND J GINGO D.C.

Table of content: DR. RAYMOND J GINGO D.C. (NPI 1427199033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427199033 NPI number — DR. RAYMOND J GINGO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GINGO
Provider First Name:
RAYMOND
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1427199033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3199 WOODS TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44240-7464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-677-0346
Provider Business Mailing Address Fax Number:
330-677-0346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3199 WOODS TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44240-7464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-677-0346
Provider Business Practice Location Address Fax Number:
330-677-0346
Provider Enumeration Date:
02/08/2007

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: 111N00000X , with the licence number:  1402 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 183500000X , with the licence number: 03-1-12128 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0716470 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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