Healthcare Provider Details

I. General information

NPI: 1992442255
Provider Name (Legal Business Name): NORTHEAST CRITICAL CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W BROAD ST
TAMAQUA PA
18252-1818
US

IV. Provider business mailing address

10 W WHITE BEAR DR
SUMMIT HILL PA
18250-1728
US

V. Phone/Fax

Practice location:
  • Phone: 570-657-1634
  • Fax: 570-645-3397
Mailing address:
  • Phone: 570-657-1634
  • Fax: 570-645-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAVID B KASPRZAK
Title or Position: CEO
Credential: CRNP
Phone: 570-657-1634