Wyoming Valley Pain Clinic & Rehabilitation Center

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD026644E Issued in PA

Legal business name

WYOMING VALLEY PAIN CLINIC & REHABILITATION CENTER

Practice address

39 S River St
Plains, PA 18705-1233

Phone

(570) 822-9514

Fax

(570) 823-8039

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Emmanuel E. Jacob, M.D.NPI 1912090689

Title

Director

Phone

(570) 822-9514

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Emmanuel Egipto Jacob, M.D

  • Specialist
  • Plains, PA
  • NPI 1912090689
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780704619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 S RIVER ST",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "187051233",
            "telephone_number": "570-822-9514",
            "fax_number": "570-823-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 S RIVER ST",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "187051233",
            "telephone_number": "570-822-9514",
            "fax_number": "570-823-8039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOMING VALLEY PAIN CLINIC & REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "570-822-9514",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD026644E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaci Wall, CRNP
• Wayne Memorial Hospital (Wayne Memorial Hospital Physician Specialty Clinic)
• Kristen Elaine Wertman, TPT
• Paul Witt, D.O.
• Paul J Witt, M.D.
• Chester C Yavorski, M.D.
• Eileen Younker, BSN CRRN
• Gabriela Yurkanin, DPM/OWNER
• Deborah Ann Zbegner, DNSC, CRNP
• Zielinski Family Dentisry

• Specialist in Plains, PA
• Providers in Plains, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.