Pediatric Practices of Northeastern PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PEDIATRIC PRACTICES OF NORTHEASTERN PA

Doing business as

Pediatric Practices of Northeastern PA

Practice address

1837 Fair Ave
Honesdale, PA 18431-2121

Phone

(570) 253-5838

Fax

(570) 253-1245

NPI assigned

Nov 23, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Robert Morton, M.D.

Title

Partner

Phone

(570) 253-5838

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Pediatric Practices of Northeastern PA Doing business as

Locations

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563840000000",
    "number": "1730162678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1837 FAIR AVE",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184312121",
            "telephone_number": "570-253-5838",
            "fax_number": "570-253-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1837 FAIR AVE",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184312121",
            "telephone_number": "570-253-5838",
            "fax_number": "570-253-1245"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27B Woodlands Dr",
            "address_purpose": "LOCATION",
            "city": "Waymart",
            "state": "PA",
            "postal_code": "184729366",
            "country_code": "US",
            "telephone_number": "570-488-9550",
            "fax_number": "570-488-9553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "62 Industrial Park Rd",
            "address_purpose": "LOCATION",
            "city": "Lake Ariel",
            "state": "PA",
            "postal_code": "184365606",
            "country_code": "US",
            "telephone_number": "570-689-7565",
            "fax_number": "570-689-4803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC PRACTICES OF NORTHEASTERN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2019-07-23",
        "status": "A",
        "authorized_official_last_name": "MORTON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "570-253-5838",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CERTIFICATION NUMBER",
            "identifier": "39-3887",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100742260015",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100742260018",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100742260016",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Practices of Northeastern PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Practices of Northeastern PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeanette Parker, NP-C, DNP, APRN
• Nina Pascolini, LPC
• Deidre Patrisso, ATHLETIC TRAINER
• Kimlyn Patten, CNM
• Kristina Nicole Peary, L.P.C.
• Joanne F Pellicane, MD
• Pennsylvania CVS Pharmacy, L.L.C. (CVS Pharmacy #01587)
• Jessica Marie Peters, MSW, LSW
• Allyson Margaret Petschauer
• Philip C Gutherz MD LLC

• Rural Health Clinic/Center in Honesdale, PA
• Providers in Honesdale, PA by specialty
• Rural Health Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; 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.