Healthcare Provider Details

I. General information

NPI: 1578646907
Provider Name (Legal Business Name): COGNETTI & CONABOY FAM PRAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 JEFFERSON AVENUE
SCRANTON PA
18510
US

IV. Provider business mailing address

802 JEFFERSON AVENUE
SCRANTON PA
18510
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7331
  • Fax: 570-346-0411
Mailing address:
  • Phone: 570-346-7331
  • Fax: 570-346-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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:

VIII. Authorized Official

Name: PETER A COGNETTI
Title or Position: OWNER
Credential: MD
Phone: 570-346-7331