Healthcare Provider Details

I. General information

NPI: 1982366423
Provider Name (Legal Business Name): S4K HAZLETON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 S CHURCH ST
HAZLETON PA
18201-6266
US

IV. Provider business mailing address

98 S CHURCH ST
HAZLETON PA
18201-6266
US

V. Phone/Fax

Practice location:
  • Phone: 570-599-8140
  • Fax:
Mailing address:
  • Phone: 570-599-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL E SKOLNICK
Title or Position: PRESIDENT
Credential: DMD
Phone: 973-715-5963