Provider Demographics
NPI:1396858601
Name:DIABETES AND ENDOCRINE CENTER OF CLEVELAND INC
Entity Type:Organization
Organization Name:DIABETES AND ENDOCRINE CENTER OF CLEVELAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-504-0001
Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4337
Mailing Address - Country:US
Mailing Address - Phone:216-504-0001
Mailing Address - Fax:216-504-0005
Practice Address - Street 1:3733 PARK EAST DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4337
Practice Address - Country:US
Practice Address - Phone:216-504-0001
Practice Address - Fax:216-504-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056791207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0313342Medicaid
OH0919546Medicaid
OH0313342Medicaid