Healthcare Provider Details

I. General information

NPI: 1548277635
Provider Name (Legal Business Name): RAYMOND J LEYKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E STATE ST
SALEM OH
44460-2423
US

IV. Provider business mailing address

4105 STRATFORD RD
BOARDMAN OH
44512-1068
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-7375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number35078365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: