National Provider Identifier Database

PEDIATRIC PRACTICES OF NORTHEASTERN PA
Rural Health


Contact Information

PEDIATRIC PRACTICES OF NORTHEASTERN PA
27B WOODLANDS DR
WAYMART, PA18472-9366
Phone: 570-448-9550
Fax: 570-488-9553
Website:
Specialty Taxonomy Code
* Rural Health 261QR1300X
Pediatrics 208000000X

* Indicates primary specialty

NPI Profile & details for PEDIATRIC PRACTICES OF NORTHEASTERN PA

NPI Number 1578895538
Legal business name
LBN
PEDIATRIC PRACTICES OF NORTHEASTERN PA
Authorized official ROBERT MORTON - (PARTNER)
Entity Organization
Organization subpart No
Enumeration date 02/02/2010
Last updated 07/23/2019 - About 7 years ago
Sole proprietor1 Not specified
Identifiers
  • PA Medicaid: 1007422260018
  • PA Other: 39-3906 CMS CERTIFICATION NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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