1770145443 NPI number — MR. STEVEN JOSEPH SISK RBT, B.A.

Table of content: MR. STEVEN JOSEPH SISK RBT, B.A. (NPI 1770145443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770145443 NPI number — MR. STEVEN JOSEPH SISK RBT, B.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SISK
Provider First Name:
STEVEN
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RBT, B.A.
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:
1770145443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3707 REDFERN RD LOWR LEVEL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44134-3353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-307-4332
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
347 MIDWAY BLVD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-2496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-324-5555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2019

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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