Provider Demographics
NPI:1356373344
Name:ANDREFSKY, JOHN CHARLES (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:ANDREFSKY
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-473-8120
Mailing Address - Fax:440-473-8121
Practice Address - Street 1:6115 POWERS BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5469
Practice Address - Country:US
Practice Address - Phone:440-743-8120
Practice Address - Fax:440-743-8121
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350667202084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH130025850OtherRAILROAD MEDICARE
OH0146809Medicaid
OHAN4095264Medicare ID - Type Unspecified
OH0146809Medicaid