Provider Demographics
NPI:1588363121
Name:MAGISTRO, JOSEPH JOHN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:MAGISTRO
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 1:234 E HOWE RD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1007
Mailing Address - Country:US
Mailing Address - Phone:330-801-0619
Mailing Address - Fax:
Practice Address - Street 1:234 E HOWE RD
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1007
Practice Address - Country:US
Practice Address - Phone:330-801-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7717144385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH385HR2060XMedicaid