Provider Demographics
NPI:1508630385
Name:PASICZNYK, PAUL GREGORY
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GREGORY
Last Name:PASICZNYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 FIRESTONE TRCE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1186
Mailing Address - Country:US
Mailing Address - Phone:216-233-2053
Mailing Address - Fax:
Practice Address - Street 1:2054 FIRESTONE TRCE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-1186
Practice Address - Country:US
Practice Address - Phone:216-233-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services