Healthcare Provider Details

I. General information

NPI: 1922114248
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOC OF HAZELTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N CHURCH ST
HAZLETON PA
18202-1446
US

IV. Provider business mailing address

1090 N CHURCH ST
HAZLETON PA
18202-1446
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-1485
  • Fax: 570-459-6354
Mailing address:
  • Phone: 570-459-1485
  • Fax: 570-459-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0016935350003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. FRANCISCO A GAZEK
Title or Position: PRESIDENT
Credential: MD
Phone: 570-459-1485