Provider Demographics
NPI:1528078409
Name:NYE, JOSEPH T (CP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:NYE
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4061
Mailing Address - Country:US
Mailing Address - Phone:419-355-1004
Mailing Address - Fax:419-355-1014
Practice Address - Street 1:1442 E STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4061
Practice Address - Country:US
Practice Address - Phone:419-355-1004
Practice Address - Fax:419-355-1014
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP.82222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156352Medicaid
OH5257300001Medicare NSC