Organization Active NPI

Northeast Psychiatry Associates LLC

  • Psychiatry Physician
  • Fairlawn, OH
National Provider Identifier
1346886751
Registry record updated Mar 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
NORTHEAST PSYCHIATRY ASSOCIATES LLC
Practice address
3610 W Market St Ste 103
Fairlawn, OH 44333-9301
Phone
(330) 576-3048
Fax
(234) 466-8025
NPI assigned
Nov 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Manzoor Elahi, MDNPI 1174621221
Title
Member
Phone
(330) 576-3048

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3610 W Market St Ste 103
Fairlawn, OH 44333-9301

Mailing address

3610 W Market St Ste 103
Fairlawn, OH 44333-9301
Phone (330) 576-3048

Other identifiers 1

IdentifierTypeStateIssuer
0383096MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200211002495 OH Part B Supplier - Clinic/Group Practice 2961838966 Receives reassigned benefits from 2 practitioners
Practice locations: Fairlawn, OH

National Provider Directory

National Provider Directory

Locations

3610 W Market St
Ste 103
Fairlawn, OH 44333
Phone (330) 576-3048

3610 W Market St
Ste 102
Fairlawn, OH 44333
Phone (330) 666-5004

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709942400000",
    "number": "1346886751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 W MARKET ST STE 103",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443339301",
            "telephone_number": "330-576-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 W MARKET ST STE 103",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443339301",
            "telephone_number": "330-576-3048",
            "fax_number": "234-466-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST PSYCHIATRY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2024-03-09",
        "certification_date": "2024-03-09",
        "status": "A",
        "authorized_official_last_name": "ELAHI",
        "authorized_official_first_name": "MANZOOR",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "330-576-3048",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0383096",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.