Provider Demographics
NPI:1912950502
Name:SIDLOSKI, JAY E (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:E
Last Name:SIDLOSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:41201 SCHADDEN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2220
Practice Address - Country:US
Practice Address - Phone:440-324-0401
Practice Address - Fax:440-324-0405
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007091207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000331597OtherANTHEM
OHE07091OtherSUMMACARE
OH7993540OtherAETNA
OH05125OtherKAISER
OH341832420027OtherCARE SOURCE
OH2469001Medicaid
OHP00129474OtherRAILROAD MEDICARE
OH1000081OtherQUAL CHOICE
OH2469001Medicaid
OH7993540OtherAETNA