Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 35-079642 | OH |
NPI | 1861572364 |
---|---|
Provider Name | Dr. Nykolai Vasil Pidhorodeckyj |
First Address | Copley, OH 44321-2926 |
Second Address | Fairlawn, OH 44333-4176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 02/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H41834 | (02) | OH |