Healthcare Provider Details

I. General information

NPI: 1396919940
Provider Name (Legal Business Name): MAIN STREET HEALTH ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 SOUTH MAIN STREET
PITTSTON PA
18640
US

IV. Provider business mailing address

135 SOUTH MAIN STREET
PITTSTON PA
18640
US

V. Phone/Fax

Practice location:
  • Phone: 570-655-4404
  • Fax: 570-655-4562
Mailing address:
  • Phone: 570-655-4404
  • Fax: 570-655-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007061L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013491L
License Number StatePA

VIII. Authorized Official

Name: VINCENT ROSS ARGENIO
Title or Position: PRESIDENT
Credential: DC
Phone: 570-655-4404