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1306055322 NPI number — AMIR M POREH PHD

NPI Number: 1306055322
Health Care Provider/Practitioner: AMIR M POREH PHD

Information about “1306055322” NPI (AMIR M POREH PHD) exists in 1306055322 in HTML format HTML  |  1306055322 in plain Text format TXT  |  1306055322 in PDF (Portable Document Format) PDF  |  1306055322 in an XML format XML  formats.

NPI Number : 1306055322 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306055322",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POREH",
    "FirstName": "AMIR",
    "MiddleName": "M",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "24701 EUCLID AVE",
    "SecondLineMailingAddress": "3RD FLOOR",
    "MailingAddressCityName": "EUCLID",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44117-1714",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3401 ENTERPRISE PKWY STE 340",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEACHWOOD",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44122-7340",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "216-577-9342",
    "PracticeLocationAddressFaxNumber": "855-506-8346",
    "EnumerationDate": "05/22/2007",
    "LastUpdateDate": "01/05/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103G00000X",
          "TaxonomyName": "Clinical Neuropsychologist",
          "LicenseNumber": "6082",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "6082",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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