Provider Demographics
NPI:1740298686
Name:CENTER FOR MIND-BODY MEDICINE
Entity type:Organization
Organization Name:CENTER FOR MIND-BODY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOREM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-665-8209
Mailing Address - Street 1:4125 MEDINA RD
Mailing Address - Street 2:209
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2483
Mailing Address - Country:US
Mailing Address - Phone:330-665-8209
Mailing Address - Fax:330-665-8234
Practice Address - Street 1:4125 MEDINA RD
Practice Address - Street 2:209
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2483
Practice Address - Country:US
Practice Address - Phone:330-665-8209
Practice Address - Fax:330-665-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0423722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA78059Medicare UPIN