Provider Demographics
NPI:1285780031
Name:NEW HORIZON DERMATOLOGY, INC
Entity type:Organization
Organization Name:NEW HORIZON DERMATOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-296-2879
Mailing Address - Street 1:6693 N CHESTNUT ST STE 125A
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3900
Mailing Address - Country:US
Mailing Address - Phone:330-296-2879
Mailing Address - Fax:330-296-4656
Practice Address - Street 1:6693 N CHESTNUT ST STE 125A
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3900
Practice Address - Country:US
Practice Address - Phone:330-296-2879
Practice Address - Fax:330-296-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-30985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND292581828002OtherMEDICAL MUTUAL
ND000000352318OtherANTHEM
OHH11611Medicare UPIN
OH9349181Medicare PIN
OH9349181Medicare ID - Type Unspecified