Provider Demographics
NPI:1982290474
Name:ROSKOVICS, SALLY J
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:ROSKOVICS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 HARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4017
Mailing Address - Country:US
Mailing Address - Phone:440-850-2738
Mailing Address - Fax:
Practice Address - Street 1:223 E JEFFERSON ST APT 20
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1151
Practice Address - Country:US
Practice Address - Phone:440-994-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty