| NPI | 1538714092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH VICCICA Member 570-299-0037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2026-04-07 |