Healthcare Provider Details

I. General information

NPI: 1033171095
Provider Name (Legal Business Name): NEWBURY FAMILY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 KINSMAN RD
NEWBURY OH
44065-9792
US

IV. Provider business mailing address

10780 KINSMAN RD PO BOX 537
NEWBURY OH
44065-9792
US

V. Phone/Fax

Practice location:
  • Phone: 440-564-5656
  • Fax: 440-564-5719
Mailing address:
  • Phone: 440-564-5656
  • Fax: 440-564-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN M TAKACS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 440-564-5656