Facts
- Status
- A
- Credential
- DC
- Type
- Individual
- Enumeration date
- 2019-09-30
- Last updated
- 2020-06-02
Specialties
Licenses
- License PA
- DC011510
Location
- Practice location
- 1730 E BROAD ST
- City
- HAZLETON PA
- Postal code
- 182015657
- Phone
- 570-497-4150
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.