Provider Demographics
NPI:1619246469
Name:SALLY SCHKOLNIK D.P.M., INC.
Entity Type:Organization
Organization Name:SALLY SCHKOLNIK D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SCHKOLNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-291-6000
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-291-6000
Mailing Address - Fax:216-291-6013
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 309
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-291-6000
Practice Address - Fax:216-291-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2317213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618184Medicaid
OHT80727Medicare UPIN
OHSA0578811Medicare PIN