Active NPI
John Lisiak Jr., D.O.
- Internal Medicine Physician
- Clarks Summit, PA
National Provider Identifier
1194868091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- OS013862
- Practice address
- 611 Morgan Hwy
Clarks Summit, PA 18411-9128 - Phone
- (570) 585-6700
- Fax
- (570) 585-6714
- NPI assigned
- Feb 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OS013862 | PA | Primary |
Addresses
Primary practice location
611 Morgan Hwy
Clarks Summit, PA 18411-9128
Mailing address
844 Elm St
Olyphant, PA 18447-2136
Phone (972) 922-1342
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS013862 | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194868091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "844 ELM ST",
"city": "OLYPHANT",
"state": "PA",
"postal_code": "184472136",
"telephone_number": "972-922-1342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 MORGAN HWY",
"city": "CLARKS SUMMIT",
"state": "PA",
"postal_code": "184119128",
"telephone_number": "570-585-6700",
"fax_number": "570-585-6714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISIAK",
"first_name": "JOHN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "OS013862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarks Summit, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.