1669550653 NPI number — ALLERGY & ASTHMA CENTER OF NORTHEAST OHIO

Table of content: MR. WILLIAM RAYMOND LETENDRE SR. MS RPH MBA (NPI 1689602948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669550653 NPI number — ALLERGY & ASTHMA CENTER OF NORTHEAST OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY & ASTHMA CENTER OF NORTHEAST OHIO
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:
6
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:
1669550653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 W BOWERY ST
Provider Second Line Business Mailing Address:
SUITE 4500
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44308-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-762-7475
Provider Business Mailing Address Fax Number:
330-253-2412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W BOWERY ST
Provider Second Line Business Practice Location Address:
SUITE 4500
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44308-1069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-762-7475
Provider Business Practice Location Address Fax Number:
330-253-2412
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KISHORE
Authorized Official First Name:
RAJEEV
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
330-762-7475

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD6471 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2117097 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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