Healthcare Provider Details

I. General information

NPI: 1629786579
Provider Name (Legal Business Name): JANERICH PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER SWITZER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 570-824-4111