Provider Demographics
NPI:1568413136
Name:NEO PET I, LLC
Entity Type:Organization
Organization Name:NEO PET I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRALDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-439-5145
Mailing Address - Street 1:34555 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1068
Mailing Address - Country:US
Mailing Address - Phone:440-893-9949
Mailing Address - Fax:
Practice Address - Street 1:4411 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2509
Practice Address - Country:US
Practice Address - Phone:419-517-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0864-IC261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2549282Medicaid
OH2549282Medicaid