Healthcare Provider Details

I. General information

NPI: 1043373459
Provider Name (Legal Business Name): NORTHEAST ORTHOPEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WETHERBY LN
WESTERVILLE OH
43081-4957
US

IV. Provider business mailing address

164 WETHERBY LN
WESTERVILLE OH
43081-4957
US

V. Phone/Fax

Practice location:
  • Phone: 614-839-2300
  • Fax: 614-839-2301
Mailing address:
  • Phone: 614-839-2300
  • Fax: 614-839-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOH

VIII. Authorized Official

Name: MERLE KENNEDY
Title or Position: PHYSICIAN
Credential: MD
Phone: 614-839-2300