Provider Demographics
NPI:1649250572
Name:ASHTABULA ORTHOPAEDICS, INC.
Entity type:Organization
Organization Name:ASHTABULA ORTHOPAEDICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-997-6646
Mailing Address - Street 1:PO BOX 1425
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-1425
Mailing Address - Country:US
Mailing Address - Phone:440-997-6646
Mailing Address - Fax:440-992-4238
Practice Address - Street 1:2131 LAKE AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3466
Practice Address - Country:US
Practice Address - Phone:440-997-6646
Practice Address - Fax:440-992-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4336207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CM3156OtherRAILROAD MEDICARE
0234250001Medicare NSC
CM3156OtherRAILROAD MEDICARE