Provider Demographics
NPI:1275833238
Name:FRACTEL, INC
Entity Type:Organization
Organization Name:FRACTEL, INC
Other - Org Name:FRACTEL SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHNAYDER
Authorized Official - Suffix:
Authorized Official - Credentials:CST/CFA
Authorized Official - Phone:614-205-0295
Mailing Address - Street 1:4402 PANTONBURY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9051
Mailing Address - Country:US
Mailing Address - Phone:614-205-0295
Mailing Address - Fax:730-731-0414
Practice Address - Street 1:4402 PANTONBURY ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9051
Practice Address - Country:US
Practice Address - Phone:614-205-0295
Practice Address - Fax:730-731-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH246ZC0007X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty