Healthcare Provider Details

I. General information

NPI: 1588558027
Provider Name (Legal Business Name): GREGORY S SKOMSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PIERCE ST STE 203
KINGSTON PA
18704-5149
US

IV. Provider business mailing address

64 WOODCREST DR
PLAINS PA
18702-6962
US

V. Phone/Fax

Practice location:
  • Phone: 570-661-1061
  • Fax:
Mailing address:
  • Phone: 570-535-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW142867
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: