Healthcare Provider Details

I. General information

NPI: 1104929470
Provider Name (Legal Business Name): NORTHEASTERN OCCUPATIONAL MEDICINE & REHABILITATION CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 KEYSTONE INDUSTRIAL PARK
DUNMORE PA
18512
US

IV. Provider business mailing address

769 KEYSTONE INDUSTRIAL PARK
DUNMORE PA
18512
US

V. Phone/Fax

Practice location:
  • Phone: 570-341-7777
  • Fax: 570-341-7789
Mailing address:
  • Phone: 570-341-7777
  • Fax: 570-341-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK J. FRICCHIONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 570-341-7777