Healthcare Provider Details

I. General information

NPI: 1972539815
Provider Name (Legal Business Name): JOHN MENIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W END RD
HANOVER TOWNSHIP PA
18706-5448
US

IV. Provider business mailing address

610 WYOMING AVE
KINGSTON PA
18704-3702
US

V. Phone/Fax

Practice location:
  • Phone: 570-208-4035
  • Fax: 570-208-4038
Mailing address:
  • Phone: 570-288-5441
  • Fax: 570-288-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD025340E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: