Organization
FIFTH AVENUE OTOLARYNGOLOGISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA R. RICCIARDULLI (OFFICE MANAGER)
(330) 629-2144
Entity
Organization
Contact information
Practice address
7227 GLENWOOD AVE, YOUNGSTOWN, OH 44512-4853
(330) 629-2144
(330) 629-2140
Mailing address
7227 GLENWOOD AVE, YOUNGSTOWN, OH 44512-4853
(330) 629-2144
(330) 629-2140
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
50088404
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000252392
ANTHEM GROUP ID
OH
05
—
0666819
—
OH
01
—
099857
HIGHMARK
—
01
—
278113
KEYSTONE HEALTH PLAN
—
01
—
CE5013
RAILROAD MEDICARE
—
Enumeration date
10/04/2006
Last updated
11/13/2020
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