| NPI | 1619163706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALDINE H MALLOY Credentialing Specialist 570-386-2366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: PA MD068106L) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2007-09-21 |