Healthcare Provider Details

I. General information

NPI: 1306202593
Provider Name (Legal Business Name): JARED GEISSINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 HAMPDEN PLACE
STRAUSBURG PA
17579-1123
US

IV. Provider business mailing address

1135 HAMPDEN PLACE
STRAUSBURG PA
17579-1123
US

V. Phone/Fax

Practice location:
  • Phone: 717-687-3604
  • Fax: 717-687-3604
Mailing address:
  • Phone: 717-687-3604
  • Fax: 717-687-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA058102
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: