Healthcare Provider Details

I. General information

NPI: 1578590980
Provider Name (Legal Business Name): THE CENTER FOR INTEGRATIVE MEDICINE AT INNER HARMONY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 JEFFERSON AVE SUITE 104
SCRANTON PA
18510
US

IV. Provider business mailing address

743 JEFFERSON AVE SUITE 104
SCRANTON PA
18510
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-4621
  • Fax: 570-346-5109
Mailing address:
  • Phone: 570-346-4621
  • Fax: 570-346-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0018654700006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. BARRY IRVING EISENBERG
Title or Position: DIRECTOR
Credential: D.O.
Phone: 570-346-4621