Healthcare Provider Details

I. General information

NPI: 1275011660
Provider Name (Legal Business Name): BLONDEK CENTER FOR PEDIATRIC HEALTH & WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 08/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 MAIN STREET
DICKSON CITY PA
18519
US

IV. Provider business mailing address

247 MAIN STREET
DICKSON CITY PA
18519-1641
US

V. Phone/Fax

Practice location:
  • Phone: 570-382-3665
  • Fax:
Mailing address:
  • Phone: 570-382-3665
  • Fax: 570-483-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STANLEY W BLONDEK
Title or Position: PRESIDENT570
Credential: MD
Phone: 570-466-9747