Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LPO.00220 | OH |
N | 222Z00000X | Podiatrist | LPO.00220 | OH |
Y | 224P00000X | Prosthetist | LPO.00220 | OH |
NPI | 1144742008 |
---|---|
Provider Name | Mr. Jonathan Heifetz |
First Address | South Euclid, OH 44121-3317 |
Second Address | South Euclid, OH 44121-3317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 12/07/2017 |