Healthcare Provider Details

I. General information

NPI: 1720050487
Provider Name (Legal Business Name): PITTSTON MEDICAL ASSOCIATES LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 S TOWNSHIP BLVD SUITE A
PITTSTON PA
18640-3247
US

IV. Provider business mailing address

1099 S TOWNSHIP BLVD SUITE A
PITTSTON PA
18640-3247
US

V. Phone/Fax

Practice location:
  • Phone: 570-655-1495
  • Fax: 570-655-6945
Mailing address:
  • Phone: 570-655-1495
  • Fax: 570-655-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number000417
License Number StatePA

VIII. Authorized Official

Name: DR. JAMES R BRUNO
Title or Position: TREASURER OFFICER
Credential: MD
Phone: 570-655-9107