Healthcare Provider Details

I. General information

NPI: 1730774134
Provider Name (Legal Business Name): MR. BRIAN KUZNIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 FAIRMEADOW DR
AUSTINTOWN OH
44515-2218
US

IV. Provider business mailing address

153 FAIRMEADOW DR
AUSTINTOWN OH
44515-2218
US

V. Phone/Fax

Practice location:
  • Phone: 330-398-4245
  • Fax:
Mailing address:
  • Phone: 330-673-1347
  • Fax: 330-678-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: