Basic Information
| Provider Information | |||||||||
| NPI: | 1174540967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRFIELD NEUROLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
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| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431300550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406875164 | ||||||||
| FaxNumber: | 7406541417 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 N EWING ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431303382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406891812 | ||||||||
| FaxNumber: | 7406891810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | JANUSZ | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7406891812 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.