Healthcare Provider Details

I. General information

NPI: 1205040706
Provider Name (Legal Business Name): DRS. GELB & ROGOVIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 WHIPPLE AVE NW
CANTON OH
44718-2933
US

IV. Provider business mailing address

3731 WHIPPLE AVE NW
CANTON OH
44718-2933
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-3363
  • Fax: 330-493-3876
Mailing address:
  • Phone: 330-493-3363
  • Fax: 330-493-3876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36-00-1570
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36-00-1550
License Number StateOH

VIII. Authorized Official

Name: DR. JON ROGOVIN
Title or Position: CO-OWNER
Credential: DPM
Phone: 330-493-3363