Healthcare Provider Details

I. General information

NPI: 1790088771
Provider Name (Legal Business Name): MJA HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 E BROWN ST
EAST STROUDSBURG PA
18301-9101
US

IV. Provider business mailing address

391 E BROWN ST
EAST STROUDSBURG PA
18301-9101
US

V. Phone/Fax

Practice location:
  • Phone: 570-872-9800
  • Fax: 570-872-9888
Mailing address:
  • Phone: 570-872-9800
  • Fax: 570-872-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD424898
License Number StatePA

VIII. Authorized Official

Name: DR. MIKHAIL J ARTAMONOV
Title or Position: PRESIDENT
Credential: M.D
Phone: 570-872-9800