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21 E State St Ste 200 Columbus OH 43215-0109 | |
| (203) 568-6065 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 21 E State St Ste 200, Columbus, Ohio |
| Authorized Official Name and Position | Steven Dov Zauderer (CEO) |
| Authorized Official Contact | 2035686065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
21 E State St Ste 200 Columbus OH 43215-0109 Ph: () - | 21 E State St Ste 200 Columbus OH 43215-0109 Ph: (203) 568-6065 |
| NPI Number | 1780449140 |
|---|---|
| Provider Enumeration Date | 02/15/2024 |
| Last Update Date | 11/20/2024 |
| Certification Date | 11/20/2024 |
| Medicare PECOS PAC ID | 5496291601 |
|---|---|
| Medicare Enrollment ID | O20240724002214 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780449140 | NPI | - | NPPES |
| 0074367 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jordan Grodko |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053860452 PECOS PAC ID: 7113463225 Enrollment ID: I20240725001521 |
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