Healthcare Provider Details

I. General information

NPI: 1760413595
Provider Name (Legal Business Name): CEDAR EMERGENCY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S CHURCH ST SUITE B
HAZLETON PA
18201-6279
US

IV. Provider business mailing address

101 S CHURCH ST SUITE B
HAZLETON PA
18201-6279
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-2692
  • Fax: 570-501-2695
Mailing address:
  • Phone: 570-501-2692
  • Fax: 570-501-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOS007636L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0019549630004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. PAUL J TAYOUN
Title or Position: PRESIDENT
Credential: DO
Phone: 570-501-2692