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General NPI Number Information
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NPI Number | 1558774133
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Entity Type | Organization
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Legal Business Name | JOHN S VENGLARCIK III
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 819 MCKAY CT STE B3
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City | BOARDMAN
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State | OH
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Zip | 44512-5771
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Country | US
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Telephone | 330-884-3993
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Fax | 330-884-0516
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Provider Business Mailing Address
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Address Line | 819 MCKAY CT STE B3
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City | BOARDMAN
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State | OH
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Zip | 44512-5771
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Country | US
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Telephone | 330-884-3993
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Fax | 888-439-5935
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Authorized Official
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Title or Position | MANAGER
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Name | MARGARET VENGLARCIK
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Credential |
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Telephone | 330-884-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 350488666
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License Number State | OH
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