Healthcare Provider Details

I. General information

NPI: 1104878412
Provider Name (Legal Business Name): NORTHEASTERN REHABILITATION ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MORGAN HWY SUITE 4
SCRANTON PA
18508-2641
US

IV. Provider business mailing address

5 MORGAN HWY SUITE 4
SCRANTON PA
18508-2641
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-3788
  • Fax: 570-969-9280
Mailing address:
  • Phone: 570-344-3788
  • Fax: 570-969-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA MONAHAN-GATTO
Title or Position: CEO
Credential:
Phone: 570-344-3788