Healthcare Provider Details

I. General information

NPI: 1487558078
Provider Name (Legal Business Name): STRATUM OF PENNSYLVANIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BROADWAY
BANGOR PA
18013-2665
US

IV. Provider business mailing address

55 BROADWAY
BANGOR PA
18013-2665
US

V. Phone/Fax

Practice location:
  • Phone: 484-276-3277
  • Fax:
Mailing address:
  • Phone: 484-276-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JUSTIN WILLIAM KLEPPE
Title or Position: OWNER
Credential: FNP
Phone: 484-276-3277