Healthcare Provider Details

I. General information

NPI: 1992985907
Provider Name (Legal Business Name): NORTHEASTERN OHIO FOOT AND ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8588 E MARKET ST
WARREN OH
44484-2339
US

IV. Provider business mailing address

8588 E MARKET ST
WARREN OH
44484-2339
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-4444
  • Fax:
Mailing address:
  • Phone: 330-856-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002617
License Number StateOH

VIII. Authorized Official

Name: JAMES LAPOLLA
Title or Position: OWNER
Credential: DPM
Phone: 330-856-4444