Healthcare Provider Details

I. General information

NPI: 1982958898
Provider Name (Legal Business Name): NORTHEAST HYPERBARIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S ROBINSON AVE 1ST FLOOR
PEN ARGYL PA
18072-1946
US

IV. Provider business mailing address

PO BOX 241
DELAWARE WATER GAP PA
18327-0241
US

V. Phone/Fax

Practice location:
  • Phone: 610-881-4025
  • Fax: 610-881-4066
Mailing address:
  • Phone: 610-881-4025
  • Fax: 610-881-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC002906L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberSC002906L
License Number StatePA

VIII. Authorized Official

Name: DR. JOHN S STARISNKI
Title or Position: PRESIDENT
Credential: DPM
Phone: 610-881-4025