Healthcare Provider Details

I. General information

NPI: 1720426554
Provider Name (Legal Business Name): STEVEN JOSEPH HUMANSKY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4226
US

IV. Provider business mailing address

1011 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4226
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-2888
  • Fax: 330-629-8940
Mailing address:
  • Phone: 330-629-2888
  • Fax: 330-629-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003742
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056044
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: