1740250968 NPI number — MRS. JENNIFER L NYITRAY PA

Table of content: MRS. JENNIFER L NYITRAY PA (NPI 1740250968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740250968 NPI number — MRS. JENNIFER L NYITRAY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NYITRAY
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOBS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740250968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 SAINT CLAIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT MARYS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45885-2494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-394-3335
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 HAGER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT MARYS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45885-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-394-9992
Provider Business Practice Location Address Fax Number:
419-394-9629
Provider Enumeration Date:
01/23/2006

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: 363A00000X , with the licence number:  1959 , 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: 0068216 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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