Provider Demographics
NPI:1548587140
Name:IARUSSI, NICHOLAS ROBERT
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:IARUSSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7913 CHARDON RD
Mailing Address - Street 2:UNIT #6
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9541
Mailing Address - Country:US
Mailing Address - Phone:440-256-4358
Mailing Address - Fax:440-256-4359
Practice Address - Street 1:7913 CHARDON RD
Practice Address - Street 2:UNIT #6
Practice Address - City:KIRTLAND
Practice Address - State:OH
Practice Address - Zip Code:44094-9541
Practice Address - Country:US
Practice Address - Phone:440-256-4358
Practice Address - Fax:440-256-4359
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies