Provider Demographics
NPI:1144742008
Name:HEIFETZ, JONATHAN (CPO)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:HEIFETZ
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S GREEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3317
Mailing Address - Country:US
Mailing Address - Phone:216-371-0660
Mailing Address - Fax:
Practice Address - Street 1:2120 S GREEN RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3317
Practice Address - Country:US
Practice Address - Phone:216-371-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO.00220222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist