Healthcare Provider Details

I. General information

NPI: 1336159508
Provider Name (Legal Business Name): ALBERT DAVID JANERICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WYOMING AVE
WEST PITTSTON PA
18643-2742
US

IV. Provider business mailing address

901 WYOMING AVE
WEST PITTSTON PA
18643-2742
US

V. Phone/Fax

Practice location:
  • Phone: 570-824-4111
  • Fax: 570-824-3167
Mailing address:
  • Phone: 570-824-4111
  • Fax: 570-824-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD021055E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: