Provider Demographics
NPI:1083660138
Name:ZAJAC, JOHN J (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:6505 MARKET ST
Practice Address - Street 2:BUILDING B
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3457
Practice Address - Country:US
Practice Address - Phone:330-758-1065
Practice Address - Fax:330-286-5396
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN151392367500000X
PARN347015L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01360510OtherMEDICARE RAILROAD
OH000000690230OtherANTHEM BCBS
OH0824835Medicaid
OH8210996OtherMEDICARE PTAN