Provider Demographics
NPI:1538736764
Name:OSTROW, JEFFREY DAVID (INDEPENDENT CARE PRO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:OSTROW
Suffix:
Gender:M
Credentials:INDEPENDENT CARE PRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 W RANCHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2757
Mailing Address - Country:US
Mailing Address - Phone:216-889-3531
Mailing Address - Fax:
Practice Address - Street 1:4511 W RANCHVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2757
Practice Address - Country:US
Practice Address - Phone:216-889-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1831638347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle