Provider Demographics
NPI:1508167446
Name:PISZEL PAIN MANAGEMENT SYSTEM LLC
Entity Type:Organization
Organization Name:PISZEL PAIN MANAGEMENT SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PISZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-361-4610
Mailing Address - Street 1:50 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1347
Mailing Address - Country:US
Mailing Address - Phone:440-361-4610
Mailing Address - Fax:440-466-0203
Practice Address - Street 1:50 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1347
Practice Address - Country:US
Practice Address - Phone:440-361-4610
Practice Address - Fax:440-446-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1938092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3152154Medicaid
OHDR6009Medicare PIN
OH9394721Medicare PIN