Provider Demographics
NPI:1689713448
Name:NORTHEAST OHIO FOOT & ANKLE INC
Entity Type:Organization
Organization Name:NORTHEAST OHIO FOOT & ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHELLITO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-534-5106
Mailing Address - Street 1:8588 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2339
Mailing Address - Country:US
Mailing Address - Phone:330-856-4444
Mailing Address - Fax:330-856-9033
Practice Address - Street 1:892 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1753
Practice Address - Country:US
Practice Address - Phone:330-534-5106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003129213EP1101X
PASC005955213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2319093Medicaid
9321854Medicare ID - Type Unspecified
OHU12891Medicare UPIN