Gerald M Beresny MD PC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

MD0175586E Issued in PA

Legal business name

GERALD M BERESNY MD PC

Practice address

611 University Dr
State College, PA 16801-6552

Phone

(814) 234-7280

Fax

(814) 234-2490

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Peter Marycz Jr., REP

Title

Rep

Phone

(570) 450-6206

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144303173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 517",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182010517",
            "telephone_number": "570-450-6200",
            "fax_number": "570-450-6207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 UNIVERSITY DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168016552",
            "telephone_number": "814-234-7280",
            "fax_number": "814-234-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD M BERESNY MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARYCZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "REP",
        "authorized_official_telephone_number": "570-450-6206",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "REP"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "MD0175586E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006015750001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in State College, PA
• Providers in State College, PA by specialty
• Otolaryngology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.