Northeast Knee and Joint Institute, LLC.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

NORTHEAST KNEE AND JOINT INSTITUTE, LLC.

Practice address

3832 Yalick Plaza Route 415
Unit 7
Dallas, PA 18612-7753

Phone

(570) 213-5221

Fax

(570) 227-3316

NPI assigned

Nov 8, 2017

Last updated

Jul 15, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edwin Roman, MD

Title

Owner

Phone

(570) 213-5221

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dilip Kumar Elangbam, MD

  • Internal Medicine Physician
  • Muncy, PA
  • NPI 1326008780
  Medicare reassignment Care Compare group NPD
• Jeff Hiserman, PT

  • Physical Therapist
  • Danville, PA
  • NPI 1336499615
  Medicare reassignment Care Compare group NPD
• Christian Androvette, PA

  • Physician Assistant
  • Williamsport, PA
  • NPI 1447285564
  Medicare reassignment NPD
• Joseph L Costa, CRNP

  • Nurse Practitioner
  • Williamsport, PA
  • NPI 1578802864
  Medicare reassignment NPD
• Robert Anthony Donato, D.O.

  • Obstetrics & Gynecology Physician
  • Montoursville, PA
  • NPI 1538150560
  Medicare reassignment NPD
• Boris Gabinskiy, M.D.

  • Family Medicine Physician
  • Lock Haven, PA
  • NPI 1417925496
  Medicare reassignment NPD
• Jere L Wagner, MD

  • Family Medicine Physician
  • Shamokin, PA
  • NPI 1730151358
  NPD (past)

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563148800000",
    "number": "1689187072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3367",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177010367",
            "telephone_number": "570-213-5221",
            "fax_number": "570-227-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3832 YALICK PLAZA ROUTE 415",
            "address_2": "UNIT 7",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186127753",
            "telephone_number": "570-213-5221",
            "fax_number": "570-227-3316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "460 River Ave",
            "address_purpose": "LOCATION",
            "city": "Williamsport",
            "state": "PA",
            "postal_code": "177013723",
            "country_code": "US",
            "telephone_number": "570-213-5221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEAST KNEE AND JOINT INSTITUTE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-08",
        "last_updated": "2019-07-15",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-213-5221",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Murray
• George Herbert Nahas, DDS
• Kris Nardi, LSW
• Renee Niemiec, OTR/L
• Valerie Lee Noel, M.ED.
• Northeast Knee and Joint Institute, LLC.
• Daniel Albert Nygren, RPH
• Jacqueline Patricia O'Brien
• Julie Lynn Olenak, PHARM.D.
• Richard M Oley, D.O.

• Physical Medicine & Rehabilitation Physician in Dallas, PA
• Providers in Dallas, PA by specialty
• Physical Medicine & Rehabilitation Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.