Provider Demographics
NPI:1649457805
Name:GINGO INCORPORATED
Entity type:Organization
Organization Name:GINGO INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GINGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:440-816-5333
Mailing Address - Street 1:PO BOX 92456
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0003
Mailing Address - Country:US
Mailing Address - Phone:440-816-5333
Mailing Address - Fax:
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:SUITE C112
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060907207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330767Medicaid
OH9290441Medicare PIN
OH2330767Medicaid