Healthcare Provider Details

I. General information

NPI: 1609162924
Provider Name (Legal Business Name): NICHOLAS J MISKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 E BROAD ST
HAZLETON PA
18201-5650
US

IV. Provider business mailing address

1751 E BROAD ST
HAZLETON PA
18201-5650
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-4559
  • Fax: 570-459-4558
Mailing address:
  • Phone: 570-459-4559
  • Fax: 570-459-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
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:
Title or Position:
Credential:
Phone: