Healthcare Provider Details

I. General information

NPI: 1396822334
Provider Name (Legal Business Name): AVROM D. EPSTEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 NEIL AVE SUITE 440
COLUMBUS OH
43215-7309
US

IV. Provider business mailing address

262 NEIL AVE SUITE 440
COLUMBUS OH
43215-7309
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-4166
  • Fax: 614-221-5524
Mailing address:
  • Phone: 614-221-4166
  • Fax: 614-221-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35067301
License Number StateOH

VIII. Authorized Official

Name: AVROM DAVID EPSTEIN
Title or Position: OWNER
Credential: M.D.
Phone: 614-221-4166