Provider Demographics
NPI:1609006329
Name:GARY JOSEPH DO, INC.
Entity Type:Organization
Organization Name:GARY JOSEPH DO, INC.
Other - Org Name:BODYLOGICMD OF CLEVELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-972-5265
Mailing Address - Street 1:4700 ROCKSIDE RD
Mailing Address - Street 2:SUITE 535
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2155
Mailing Address - Country:US
Mailing Address - Phone:866-972-5265
Mailing Address - Fax:866-972-5301
Practice Address - Street 1:4700 ROCKSIDE RD
Practice Address - Street 2:SUITE 535
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2155
Practice Address - Country:US
Practice Address - Phone:866-972-5265
Practice Address - Fax:866-972-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty