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

VII. Legacy identifiers

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

# 1
Identifier001252657-0006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier534357
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 3
Identifier68718
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON
# 4
Identifier0474468000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE EAST
# 5
Identifier1067
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER
# 6
Identifier20022351
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH
# 7
IdentifierCF8495
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 8
Identifier643767
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CARE/HIGHMARK BLUE SHIELD
# 9
Identifier68719
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTHREE RIVERS

VIII. Authorized Official

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