Provider Demographics
NPI:1205040706
Name:DRS. GELB & ROGOVIN, INC.
Entity Type:Organization
Organization Name:DRS. GELB & ROGOVIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-493-3363
Mailing Address - Street 1:3731 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2933
Mailing Address - Country:US
Mailing Address - Phone:330-493-3363
Mailing Address - Fax:330-493-3876
Practice Address - Street 1:3731 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2933
Practice Address - Country:US
Practice Address - Phone:330-493-3363
Practice Address - Fax:330-493-3876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-1550213ES0131X
OH36-00-1570213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0772801Medicaid
OH0772801Medicaid
OH9220041Medicare PIN