Provider Demographics
NPI:1902843063
Name:CSERNYIK, ERIC J (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:CSERNYIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5026
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:44 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2709
Practice Address - Country:US
Practice Address - Phone:440-735-3900
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005589146D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0931871Medicaid
OH000000162489OtherANTHEM
OH942460636449OtherCARESOURCE
OH000000381808OtherANTHEM
OHP00319995OtherMEDICARE TRAVELERS RR-GA
OH000000381220OtherANTHEM
OH000000561015OtherANTHEM
OHP00400170Medicare PIN
OHCS0741879Medicare PIN
OH000000381808OtherANTHEM
OH000000381220OtherANTHEM
OH000000561015OtherANTHEM