Organization Active NPI

Medical Associates of Northeastern Pennsylvania PC

  • Internal Medicine Physician
  • Scranton, PA
National Provider Identifier
1336279173
Registry record updated Aug 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD053580L Issued in PA
Legal business name
MEDICAL ASSOCIATES OF NORTHEASTERN PENNSYLVANIA PC
Practice address
1789 N. Keyser Ave.
Scranton, PA 18508
Phone
(570) 969-1904
Fax
(570) 969-2916
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2008

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

Authorized official

Name
Kaylee Pikulski
Title
Practice Manager
Phone
(570) 969-1904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD053580L PA Primary

Addresses

Primary practice location

1789 N. Keyser Ave.
Scranton, PA 18508

Mailing address

1789 N. Keyser Ave.
Scranton, PA 18508
Phone (570) 969-1904

Other identifiers 1

IdentifierTypeStateIssuer
0018171130002MedicaidPA

National Provider Directory

National Provider Directory

Locations

1789 N Keyser Ave
Scranton, PA 18508
Phone (570) 969-1904

Practitioners & affiliated clinicians

Practitioners 1

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1336279173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1789 N. KEYSER AVE.",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "18508",
            "telephone_number": "570-969-1904",
            "fax_number": "570-969-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1789 N. KEYSER AVE.",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "18508",
            "telephone_number": "570-969-1904",
            "fax_number": "570-969-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSOCIATES OF NORTHEASTERN PENNSYLVANIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "PIKULSKI",
        "authorized_official_first_name": "KAYLEE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "570-969-1904"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD053580L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018171130002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; 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.