Healthcare Provider Details

I. General information

NPI: 1881693869
Provider Name (Legal Business Name): BONE AND JOINT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S RIVER ST
PLAINS PA
18705-1137
US

IV. Provider business mailing address

220 S RIVER ST
PLAINS PA
18705-1137
US

V. Phone/Fax

Practice location:
  • Phone: 570-826-1555
  • Fax: 570-822-4445
Mailing address:
  • Phone: 570-826-1555
  • Fax: 570-822-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD052858L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberND024634L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD060164L
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL P BANAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 570-826-1555