Healthcare Provider Details

I. General information

NPI: 1730254509
Provider Name (Legal Business Name): NORTHERN TIER GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 SCRANTON CARBONDALE HWY
EYNON PA
18403-1022
US

IV. Provider business mailing address

681 SCRANTON CARBONDALE HWY
EYNON PA
18403-1022
US

V. Phone/Fax

Practice location:
  • Phone: 570-876-5900
  • Fax: 570-876-5300
Mailing address:
  • Phone: 570-876-5900
  • Fax: 570-876-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAYAN C SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 570-876-5900