Healthcare Provider Details

I. General information

NPI: 1346240793
Provider Name (Legal Business Name): NORTHEAST REGIONAL ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GALLAGHER DR
PLAINS PA
18705-1146
US

IV. Provider business mailing address

11 GALLAGHER DR
PLAINS PA
18705-1146
US

V. Phone/Fax

Practice location:
  • Phone: 570-970-1030
  • Fax: 570-270-0577
Mailing address:
  • Phone: 570-970-1030
  • Fax: 570-270-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: BARBARA KREEL
Title or Position: CEO/OWNER
Credential: MD
Phone: 570-970-1030