Healthcare Provider Details

I. General information

NPI: 1710986815
Provider Name (Legal Business Name): DARIUSZ KOSCIELNIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 05/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAGLESMERE CIR
EAST STROUDSBURG PA
18301-3144
US

IV. Provider business mailing address

100 EAGLESMERE CIR
EAST STROUDSBURG PA
18301-3144
US

V. Phone/Fax

Practice location:
  • Phone: 570-421-4331
  • Fax: 570-421-5870
Mailing address:
  • Phone: 570-421-4331
  • Fax: 570-421-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD062306L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: