Basic Information
Provider Information | |||||||||
NPI: | 1083670954 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ESSIET | ||||||||
FirstName: | BASSEY | ||||||||
MiddleName: | N. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ESSIET | ||||||||
OtherFirstName: | B | ||||||||
OtherMiddleName: | NELSON | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 525 E MARKET ST | ||||||||
Address2: | AKRON RADIOLOGY, INC. | ||||||||
City: | AKRON | ||||||||
State: | OH | ||||||||
PostalCode: | 443041619 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3303753043 | ||||||||
FaxNumber: | 3303757932 | ||||||||
Practice Location | |||||||||
Address1: | 525 E MARKET ST | ||||||||
Address2: | AKRON RADIOLOGY, INC. | ||||||||
City: | AKRON | ||||||||
State: | OH | ||||||||
PostalCode: | 443041619 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3303753043 | ||||||||
FaxNumber: | 3303757932 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/21/2006 | ||||||||
LastUpdateDate: | 06/04/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 062593 | OH | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 0923899 | 05 | OH |   | MEDICAID | 200079350A | 05 | OK |   | MEDICAID |