Active NPI
Medical Associates of Northeastern Pennsylvania PC
- Internal Medicine Physician
- Scranton, PA
National Provider Identifier
1336279173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD053580L
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018171130002 | Medicaid | PA |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Internal Medicine Physician
- Scranton, PA
- NPI 1497797179
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.