Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 213EP1101X | OH |
NPI | 1427555333 |
---|---|
Provider Name | Thomas Salvatore Ciresi JR. |
First Address | Lyndhurst, OH 44124-2515 |
Second Address | Richmond Heights, OH 44143-1116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2018 |
Last Update Date | 07/04/2018 |