Healthcare Provider Details

I. General information

NPI: 1962156968
Provider Name (Legal Business Name): RECOVERY FIRST OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1797 HILL RD N
PICKERINGTON OH
43147-7996
US

IV. Provider business mailing address

PO BOX 76
NEW ALBANY OH
43054-0076
US

V. Phone/Fax

Practice location:
  • Phone: 614-755-6370
  • Fax: 614-698-7614
Mailing address:
  • Phone: 614-755-6370
  • Fax: 614-698-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NINO DIIULLO
Title or Position: OWNER
Credential: MD
Phone: 614-306-0116