Healthcare Provider Details

I. General information

NPI: 1043323686
Provider Name (Legal Business Name): JOSEPH F BERARDELLI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ADAMS AVE SUITE 303
SCRANTON PA
18510-2025
US

IV. Provider business mailing address

401 ADAMS AVE SUITE 303
SCRANTON PA
18510-2025
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-0030
  • Fax: 570-342-1729
Mailing address:
  • Phone: 570-342-0030
  • Fax: 570-342-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA051521
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: