Provider Demographics
NPI:1730126749
Name:CONGENI, JEFFREY LEO (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEO
Last Name:CONGENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TUSCARAWAS ST W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4644
Mailing Address - Country:US
Mailing Address - Phone:330-456-0047
Mailing Address - Fax:330-456-9308
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4644
Practice Address - Country:US
Practice Address - Phone:330-456-0047
Practice Address - Fax:330-456-9308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067351C207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2012593Medicaid
OH2012593Medicaid
OHCO0824641Medicare ID - Type Unspecified