Healthcare Provider Details

I. General information

NPI: 1982891495
Provider Name (Legal Business Name): EUGENE D HARASYM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 DRINKER TURNPIKE
COVINGTON TOWNSHIP PA
18444-7948
US

IV. Provider business mailing address

RR 6 BOX 6239
MOSCOW PA
18444-9400
US

V. Phone/Fax

Practice location:
  • Phone: 570-842-0945
  • Fax: 570-842-6135
Mailing address:
  • Phone: 570-945-7347
  • Fax: 570-945-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHNNA JALOWIEC
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 570-961-9947