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General NPI Number Information
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NPI Number | 1760577787
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Entity Type | Organization
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Legal Business Name | FIFTH AVENUE OTOLARYNGOLOGISTS, INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 7227 GLENWOOD AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4853
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Country | US
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Telephone | 330-629-2144
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Fax | 330-629-2140
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Provider Business Mailing Address
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Address Line | 7227 GLENWOOD AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4853
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Country | US
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Telephone | 330-629-2144
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Fax | 330-629-2140
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANDREA R. RICCIARDULLI
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Credential |
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Telephone | 330-629-2144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 50088404
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License Number State | OH
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