Healthcare Provider Details

I. General information

NPI: 1861665606
Provider Name (Legal Business Name): NORMAN W LEFKOVITZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N MILLER RD
FAIRLAWN OH
44333-3702
US

IV. Provider business mailing address

60 N MILLER RD
FAIRLAWN OH
44333-3702
US

V. Phone/Fax

Practice location:
  • Phone: 330-864-9099
  • Fax: 330-864-9390
Mailing address:
  • Phone: 330-864-9099
  • Fax: 330-864-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35-04-9231
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number35-04-9231
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number35-04-9231
License Number StateOH

VIII. Authorized Official

Name: MRS. ANNA E CHRISTIE
Title or Position: MEDICAL ASSISTANT
Credential:
Phone: 330-864-9099