Provider Demographics
NPI:1578744116
Name:CLEVELAND CENTER FOR JOINT RECONSTRUCTION, INC
Entity Type:Organization
Organization Name:CLEVELAND CENTER FOR JOINT RECONSTRUCTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STULBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-363-2096
Mailing Address - Street 1:6896 W SNOWVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3108
Practice Address - Country:US
Practice Address - Phone:216-363-2096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0870884Medicaid
OH105758OtherKAISER PERMANENTE
OH128086800OtherDEPARTMENT OF LABOR
OH105758OtherKAISER PERMANENTE
OHCA6551Medicare PIN
OHCL9248981Medicare PIN