MEDICARE: 447 PLAZA HEART CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD039907E	PA

General Provider Information

NPI Number	:	1649395260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	447 PLAZA HEART CENTER, INC

Provider Business Mailing Address
First Line	:	373 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-9101
Country	:	US
Telephone Number	:	570-424-9970
Fax Number	:	570-424-2899

Provider Business Practice Location Address
First Line	:	373 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-9101
Country	:	US
Telephone Number	:	570-424-9970
Fax Number	:	570-424-2899

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	DR. PATRICIA ANN RYLKO
Credential	:	M.D.
Telephone Number	:	570-424-9970

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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