Healthcare Provider Details

I. General information

NPI: 1023055852
Provider Name (Legal Business Name): SCRANTON NEUROLOGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 JEFFERSON AVENUE 5TH FLOOR
SCRANTON PA
18510-1038
US

IV. Provider business mailing address

802 JEFFERSON AVENUE 5TH FLOOR
SCRANTON PA
18510-1038
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-1118
  • Fax: 570-348-1109
Mailing address:
  • Phone: 570-348-1118
  • Fax: 570-348-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology 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: MRS. LISA REGAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 570-348-3361