Provider Demographics
NPI:1043373459
Name:NORTHEAST ORTHOPEDICS INC
Entity type:Organization
Organization Name:NORTHEAST ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-839-2300
Mailing Address - Street 1:164 WETHERBY LN
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4957
Mailing Address - Country:US
Mailing Address - Phone:614-839-2300
Mailing Address - Fax:614-839-2301
Practice Address - Street 1:164 WETHERBY LN
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4957
Practice Address - Country:US
Practice Address - Phone:614-839-2300
Practice Address - Fax:614-839-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2303064Medicaid
5126128OtherAETNA
OH2303064Medicaid
OH0971040001Medicare NSC
C14738Medicare PIN