Provider Demographics
NPI:1083170351
Name:KOBYLSKI, ERIC JUSTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JUSTIN
Last Name:KOBYLSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 RUSH RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1131
Mailing Address - Country:US
Mailing Address - Phone:440-382-0825
Mailing Address - Fax:
Practice Address - Street 1:1834 RUSH RD
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1131
Practice Address - Country:US
Practice Address - Phone:440-382-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant