| NPI | 1982889713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONIA AVERS Billing Coordinator 570-283-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: PA SC004059L) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2008-03-20 |