Provider Demographics
NPI:1942530506
Name:CEDARNILE LLC
Entity Type:Organization
Organization Name:CEDARNILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHAIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-567-5600
Mailing Address - Street 1:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:OH
Mailing Address - Zip Code:44210-1243
Mailing Address - Country:US
Mailing Address - Phone:330-576-5600
Mailing Address - Fax:
Practice Address - Street 1:14805 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3934
Practice Address - Country:US
Practice Address - Phone:330-576-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2474979Medicaid
OHI02406Medicare UPIN