Healthcare Provider Details

I. General information

NPI: 1063903151
Provider Name (Legal Business Name): DR STEPHEN JADITZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAYTON RD # 478
SOUTH ABINGTON TOWNSHIP PA
18411-9376
US

IV. Provider business mailing address

105 LAYTON RD P O BOX 478
SOUTH ABINGTON TOWNSHIP PA
18411-9376
US

V. Phone/Fax

Practice location:
  • Phone: 570-586-8186
  • Fax: 570-587-0758
Mailing address:
  • Phone: 570-586-8186
  • Fax: 570-587-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS006343L
License Number StatePA

VIII. Authorized Official

Name: DR. STEPHEN JADITZ
Title or Position: PHYSICIAN
Credential: DO
Phone: 570-586-8186